The patient is a doctor, came to the clinic one year ago with a history of LBP and agonizing left sciatica. He was advised to undergo surgery at that time, but he escaped.

The patient then came 04-February-2009 complaining of left sciatica and numbness of the left foot. Exacerbation of the pain the last 2 weeks.

MRI lumbar spine performed 21-January-2009 showed huge extruded disc L5-S1 with left downward migration and lumbar canal stenosis L4-5.

On examination: the patient is limping with scoliotic stance. SLRS was limited to 80 degrees in the left with absent AJ and weak dorsi - -4/5, and planterflexion left foot - 4/5, respectively.

Decompressive laminectomy of L5 and partial of L4 with foraminotomy of left S1 root was performed. The dura was absent at L4-5 level with very transparent dural sheath. The extruded disc was removed subaxillary and part of it was adherent to the running root, which was dissected off respectively. The intradiscal space was shallow and the disc space was empty, for what no material was harvested from there. Inspection of the transparent dura at L4-5 level showed a tiny microscopic pin-point CSF leak, which was coagulated first, but the CSF continued to flow, for what 6 zero nylon was used to close the tear in one stitch. Check for CSF leak was negative. Routine closure of the wound.

Smooth postoperative recovery.

The patient has small defect of the annulus fibrosis, and the disc space height is shallow and the intradiscal space is empty, for what the estimated recurrence rate is ranking very low.

The dura was very thin, that spontaneous CSF leak took place from the thinnest point. It was managed accordingly.