The patient came to the clinic 21-June-2008 with LBP and left sciatica for 3 years with exacerbation last 3 weeks and pain and numbness left L4 territory.

MRI of the lumbar spine done 07-April-2008 showing huge extruded disc L3-4 central with left downward migration and small extrusion of the L5-S1 disc left side.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 60 degrees in the right and 70 degrees in the left with pain. There is hypalgesia of the left L4 territory with weak left quadriceps 4/5 and dorsiflexion left foot -4/5 and right foot 4/5.

Using image-intensifier the L3-4 level was identified and methyline-blue was used as a marker. Laminectomy of L3 and partial of L4 was performed with foraminotomy of both L4 roots was performed. Bilateral cleaning of the disc space of L3-4 with removal of the extrusion from both sides was done. Routine closure of the wound.

Smooth postoperative recovery and the power of both lower limbs improved.

The recurrence rate in this case is below the average, because the disc space is shallow and bilateral cleaning was performed.

To decrease the bony dissection, level acquisition by image-intensifier is recommended, especially when the level is high as L3-4 , as in this case.

Intentional neglect of L5-S1 was considered, because performing discectomy for 2 levels will increase the recurrence rate and the pain in the postoperative period bill be retracted for several  years.