The patient came to the clinic 22-April-2009 complaining of LBP for 5 years with left sciatica the last 9 months with exacerbation of sciatica the last month.

On examination: the patient was limping with weak dorsiflexion left foot 4/5 and exaggerated scoliotic stance. SLRS was 30 degrees with pain in the left with absent AJ in the left.

MRI lumbar spine, which was done 22-April-2009 showed extruded disc L4-5 with left downward migration.

The patient was advised to undergo surgery, but he disappeared.

The patient then came 10-June-2009 claiming that he improved but clinically and morphologically was the same as confirmed in the MRI performed 08-June-2009.

Using image-intensifier, the L4-5 level was identified. Left L5 foraminotomy was performed after reflection of the ligamentum flavum to the right. The old extruded disc was removed lateral to the axilla and meticulous cleaning of L4-5 disc space was achieved from the left. A flap with pedicle of surrounding fat was transferred to the root to minimizes the scar formation and the ligamentum flavum was place back in position.

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

The patient still having considerable height of the disc space, which make the expectation of recurrence higher than 7%.

So as to avoid dramatic clinical deterioration in case of possible recurrence the foraminotomy was extended more down to have ample to the root in case of recurrence. The defect in the annulus fibrosis also was opened more laterally to make the theoretically proposed recurrence go lateral to the running root.