The patient a Yemeni citizen came 21-January-2012 complaining of  LBP and right sciatica for 2 months down to the right L5 territory with progressive course. MRI lumbar spine done 11-December-2011 showing extruded disc L3-4 with right downward migration.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 70 degrees with pain the right with weak dorsiflexion 3/4 and planterflexion -4/5 right foot. The right quadriceps femoris was 4/5.

MRI of the lumbar spine was repeated 22-January-2012 which confirmed the presence of huge extrusion of L3-4 with right downward migration.

Using C-arm, the L3-4 level was identified. Through 3 cm incision, foraminotomy of right L4 root was done. The root was severely compressed by hard extrusion, which was removed lateral to the axilla. Right sided cleaning of L3-4 disc space. The dura was severely transparent and it was coagulate at one site to prevent possible CSF leak and this place was aided with muscle.

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

The patient has large extrusion which was causing severe compression of the root and the dura was so thin, that it could rupture, if attention to this not paid.

The estimated postoperative recurrence still around 7% because the disc space is still not shallow.