The patient came to the clinic 15-June-2009 complaining of left sciatica the last 6 months with exacerbation of sciatica the last 3 days making him unable to sleep.

MRI lumbar spine performed 02-April-2009 showing extruded disc L4-5 with left downward migration.

On examination: the patient was limping with exaggerated scoliotic stance and weak dorsiflexion left foot 4/5 . SLRS was 90 degrees with pain in the left. The patient was sent to another MRI which showed further enlargement of the disc.

Using image-intensifier, the L4-5 level was identified. Left L5 foraminotomy was performed after performing left L4 hemilaminectomy. The extruded disc was removed from under the axilla and meticulous cleaning of L4-5 disc space was achieved from the left lateral to the axilla. Routine closure of the wound

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.