The patient an Iraqi citizen, came to the clinic 05-January-2013 complaining of LBP and left sciatica for 5 months with difficult walking. The condition is deteriorating over the time.

MRI lumbar spine done 05-January-2013 showing huge wide-based extrusion L4-5 with severe segmental stenosis.

On examination: the patient in agonizing pain. He is limping with exaggerated scoliotic stance. SLRS 30 degrees in the right shooting the pain to the left and 5 degrees in the left with more pain. There is weak dorsiflexion left foot -4/5.

Complete laminectomy L4 and upper third of L5. Flavotomy L3-4. Bilateral foraminotomy L5 roots. The area was severely compressed and there is no epidural fat and the dura was transparent. The annulus fibrosis was inspected from the left side and it gave the feeling that the disc material is very soft, for what it was decided to perform meticulous discectomy L4-5 from the left with wide annulotomy The anterior part of the annulus fibrosis was thinned as much as be could with bipolar application to the area to trigger anterior extrusion in case of recurrence to minimizes the posterior recurrence.

Routine closure of the wound. Smooth postoperative recovery. The power of left foot became normal.

The disc space is still high and the estimated postoperative recurrence is around 15%.

To minimized the posterior recurrence, the anterior part of the annulus fibrosis was thinned and coagulated to promote anterior slippage of the disc material, reducing by that the possibility of posterior recurrence.