The patient came to the clinic 22-October-2008 complaining of LBP for 4 years with intermittent course.  The last week got exacerbation of right sciatica not reaching below the right knee.

The patient is under treatment for diabetes mellitus and arterial hypertension.

On examination: the patient is limping with exaggerated scoliotic stance, with SLRS 80 degrees in right side with pain and weak dorsi and planterflexion right foot 4/5.

MRI lumbar spine was performed 22-October-2008 showing extruded disc L2-3 with right upward migration occluding the foramen.

Using image-intensifier, the L2-3 level was identified and 0.2 ml methylen blue was used to to keep the landmark. Right L2-3 hemiflavotomy was performed and drilling of the lower part of the L2 lamina was performed from the right to catch the upward migrating piece, which was removed in several fragments. Inspection of the annulus fibrosis showed that the disc material still ready to extrude, for what meticulous cleaning of the disc space was performed from the right.

Smooth recovery with prompt improvement of the power of the right foot.

The patient has severe compression of the right L2 root with the upward migrating fragment, occluding the foramen. The neurologic deficit is not compatible with the lesion. Anyhow, neurological examination is by no means all the time can confirm the morphological lesion.

The expected recurrence rate in this case is around the average, because the disc space height is not shallow and the annulus fibrosis defect is not large enough.