The patient came to the clinic 04-November-2014 complaining of LBP with bilateral sciatica for 2 years with exacerbation last 5 months with drop left foot for this period. CT-scan of the spine done twice not informative.

On examination, the patient is limping with exaggerated scoliotic stance. There is pain when turning the head to the right, up and downward. There is weak grip left hand 3/5, extension both hands 3/5 and both triceps muscles 3/5. SLRS was 60 degrees with pain in the right and 50 degrees with pain in the left. The left foot is completely drop with weak planterflexion left foot -3/5. Weak dorsiflexion right foot 2/5 and planterflexion same foot 4/5. There is analgesia left L5 root with hypalgesia left S1 root. Weak both quadriceps 3/5. Loss of hearing left ear for 6 years.

The patient was sent for investigations and done the same day. MRI of the brain was normal. MRI of the cervical spine showed PCD C5-6 wide-based, not compressing the spinal cord. MRI lumbar spine showing huge extruded disc L1-2 more to the left causing severe stenosis. Severe stenosis of L4-5 with wide extrusion. Dynamic studies were normal.

Using the C-arm, the L1-2 level was identified. Left L1-2 hemiflavotomy was performed with drilling to achieve exposure of the area without applying traction of the spinal cord. The extruded disc was identified and removed. Intradiscal cleaning L1-2. Through another separate incision, decompressive laminectomy L4 and upper 1/3 of L5 was achieved. Foraminotomy both L5 roots was performed. Inspection of the annulus fibrosis revealed that it is better not to violate the intradiscal structures. Further foraminotomy of the left L5 root to ensure that no additional compression was present in its canal.  Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot became normal and the planterflexion of the left foot became normal. The drop left foot remained the same.

The patient still has an estimated postoperative recurrence around 15%, because the disc spaces are still not completely shallow.

It is rarely to see recovery of complete drop for when it has place for long time. Time will show if this case could be an exclusion.