The patient came to the clinic 23-August-2004 complaining of LBP with left sciatica for 7 months, then exacerbation last month. MRI lumbar spine done 19-January-2004 showing extruded disc L4-5 with  left downward migration. The patient is hypertensive for 10 years in treatment. Using L-thyroxin for 3 years. Has Gilbert disease.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 70 degrees in the right  with pain and 45 degrees in the left with more pain. There is almost drop left foot with weak planterflexion same foot 3/5.

The patient was sent for investigations and MRI done 02-September-2004 showing the extruded disc L4-5.

Foraminotomy both L5 roots with removal of the extrusion lateral to the axilla from the left side. After that, the root became lax and left sided intradiscal cleaning L4-5 disc space was done. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A fat in pedicle was transferred from the subcutaneous layer and covered the exposed parts of the dura and roots to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the left foot dramatically improved. He was sent to the ward.

The patient came to the clinic 15-Septmber-2004 with clean wound and SLRS 80 degrees both sides with no pain and normal power and sensation.

The estimated postoperative recurrence is still ranking around 7%, because the disc space is still relatively not shallow.