The patient came to the clinic 11-January-2010 complaining of LBP with right sciatica for 5 months. She was using crutches for 4 months. MRI lumbar spine performed 19-September-2009 showed bulge L5-S1 with mild stenosis L4-5 with extruded disc right side. On examination at that time, she was limping with SLRS 30 degrees in the right with weak dorsiflexion right foot -4/5 and left foot 4/5. MRI repeated 12-January-2010 which showed mild stenosis L4-5 with small extrusion and right downward migration. The patient noticed improvement of her condition after given medication, for what conservative treatment was suggested. The patient is a known diabetic for 20 years with arterial hypertension for 5 years.

The patient then came 21-June-2012 complaining of left sciatica for one month with cramps and numbness both feet with inability to walk more than 100 meters. The patient was limping with exaggerated scoliotic stance with SLRS 75 degrees in the left with pain. There is weak dorsiflexion right foot 4/5 and left foot -4/5 and planterflexion left foot 4/5.

MRI of the lumbar spine done 20-June-2012 showing LCS L4-5 with extruded disc L5-S1 with left foraminal occlusion. Another MRI was repeated 06-Septemebr-2012 showing the same data.

Decompressive laminectomy L4 and L5. Foraminotomy left S1 root. All the area was lacking epidural fat due to severe compression. The upward migrating extrusion from L5-S1 was removed from under the axilla in several pieces. Cleaning of L5-S1 was done from the left side. The left S1 root was adherent to the surrounding structures due to old extrusion, but it was totally free from any compression. Inspection of L4-5 annulus fibrosis was free of any extrusion.

Routine closure of the wound. Smooth postoperative recovery with normalization of the power of both feet.

The patient has still have an estimated postoperative recurrence below 7%, because the disc space of L5-S1 still not shallow.