The patient came to the clinic 12-January-2009 complaining of LBP for three years with left sciatica for 4 months with exacerbation of the left sciatica the last 40 days.

MRI lumbar spine performed 11-January-2009 showed extruded disc L4-5 with left foraminal occlusion and very mild degree of spondylolisthesis L3-4.

On examination: the patient is limping with exaggerated scoliotic stance with SLRS 20 degrees in the left with pain and weak dorsi -4/5 and planterflexion 4/5 left foot with hypalgesia left L5 and S1 roots territories.

Considering that the patient had elements of lumbarization of the sacrum and the very long spinous process of L5 (longer than L4 spinous process) image=intensifier was used to identify the level. Left L4-5 hemiflavotomy with foraminotomy of left L5 root was performed. The area was lacking epidural fat due to severe compression. The extruded disc was removed lateral to the axilla in one piece, after what the root became lax. Using the defect, through which the extrusion took place, meticulous cleaning of the disc space was performed from the left. The defect in the annulus fibrosis was coagulated to minimize the dimensions of the defect. Routine closure of the wound.

Smooth postoperative recovery and the weakness of the left foot disappeared after surgery.

The patient has huge extrusion of L4-5 and minimal spondylolisthesis of L3-4.

The clinical picture of the patient was due to the huge extrusion, for what removal of the extrusion was needed to resolve by surgery.

The spondylolisthesis is minimal and causing no harm for the patient, for what it was neglected and omitted from the surgical plan.