The patient came to the clinic 05-May-2009 complaining of left sciatica for 45 days down to the left S1 territory with positive cough sign. The patient is recently diagnosed diabetic, but in no medication.

MRI Lumbar spine performed 12-April-2009 showing huge extruded disc L5-S1 with up and downward migration.

On examination: the patient is limping with exaggerated scoliotic stance with SLRS 30 degrees in the left and weak dorsi 2/5 and planterflexion left foot -4/5. There is hypalgesia left S1 territory with numbness.

Foraminotomy of left S1 root with reflection of ligamentum flavum to the right and stay stitch was applied to reflect the flaval flap to the right. The extruded disc was severely compressing the root and the root was severely swollen and immovable. The disc space was shallow and cleaning of the disc space of L5-S1 was performed from the relatively wide defect in the annulus fibrosis. The extruded disc of L5-S1 was partially removed lateral to the axilla. Considering that the root is swollen and the extruded material was not adequate in quantity, comparing with the MRI data, check image-intensifier was applied and the level was right. Further inspection of the root was performed and the huge upward migrating disc pieces was possible to remove only from under the axilla? The ligamentum flavum was reflected back to cover the exposed root.

Smooth postoperative recovery with normalization of the power of the left foot.

The estimated recurrence rate in this case is below 7% since the disc space is shallow, but the defect in the annulus fibrosis was wide.

The patient is diabetic, for what monopolar coagulation was avoided to prevent thermal trauma to the tissues, so as, to decrease the possible post-operative rate of infection.

The ligamentum flavum was reflected to the right and after performing the surgery, it was retuned back to minimize the postoperative adhesions.