The patient came to the clinic 07-November-2010 complaining of LBP with left sciatica for one years with exacerbation last 6 months after RTA without improvement. The sciatica shooting to the left L5 root territory with numbness of the corresponding area.

MRI lumbar spine performed 27-October-2010 showing huge extruded disc L4-5 with left foraminal occlusion.

On examination: The patient  is in agonizing pain, limping when walking with exaggerated scoliotic stance. There is weak dorsi and planterflexion left foot -3/5 and hypalgesia below the left knee.

Left L4-5 hemiflavotomy with foraminotomy left L5 root was performed. The extruded disc was attacked lateral to the axilla and it was removed in several pieces, after what the root became lax. The disc space of L4-5 was high and meticulous cleaning of the disc space was performed from the left side. The compressed dura and the root were lacking the epidural fat.

Routine closure of the wound. Smooth postoperative recovery and improvement of the power of left foot.

The patient has huge extrusion with dark gray extrusion, which will not resolve over the time. Surgical decompression is the only solution.

The estimated recurrence rate is still above 7% because the disc space is high, despite the fact meticulous cleaning was performed from one side.