The patient came to the clinic 24-January-2012 complaining of LBP with agonizing left sciatica. The patient is Libyan citizen, during the civil was got shrapnel's to the back and right gluteal area 12-September-2011. The patient 3 weeks later got agonizing left sciatica with drop left foot. The patient performed pelvis X-ray showing 2 shrapnel's in the right gluteal area in subcutaneous layer. MRI lumbar spine performed 22-January-2012 showing huge extruded disc L4-5 with left foraminal occlusion with severe segmental stenosis and occlusion of the left S1 root.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 20 degrees with pain the left side. There is left sided hemihypalgesia  with sight weakness of the left upper limb and complete drop left foot with weak planterflexion left foot 2/5 and weak left quadriceps femoris 4/5. On inspection of the head there was hyperostosis of the right parietal region.

MRI of the brain done 25-January-2012 showing only the scalp lesion without intracranial involvement. CT-scan of the pelvis ruled out the presence of any lesions at the trajectory of the left sciatic nerve.

Complete laminectomy L5 and partial of L4. Foraminotomy L5 and S1 roots achieved in the left side. The left L5 root is severely compressed. The extruded disc was hard in consistency and it was removed partially lateral to the axilla and partially subaxillary. Left sided cleaning of L4-5 disc space. The root is hanging free. Inspection of the L5-S1 annulus fibrosis showed no fragment mobility and it was hard in consistency, for what it was decided not to violate the disc space.

Routine closure of the wounds. Smooth postoperative recovery with improvement of the power of the left foot.

The patient is having estimated postoperative recurrence around 7%, because the disc space height still not narrow.

The patient has severe neurologic impairment and the recovery period will last for long time with unknown degree of improvement.