The patient came to the clinic 06-June-2007 complaining of right sciatica for 2 weeks with LBP for 5 years. Using crutches for 1 week and positive cough sign.

MRI lumbar spine performed 31-May-2007 showed PLD L4-5 right far lateral with foraminal occlusion and small extrusion L5-S1 right side touching the right S1 root.

On examination: SLRS 30 degrees in the right and 70 degrees in the left with hypalgesia right L5 territory and weak dorsiflexion right foot 3/5. The patient was advised to continue in conservative treatment, but she came 05-August-2007 confirming no improvement at all.

On examination the hypalgesia is wide spread to involve the right L4-5 and S1 roots with weak dorsi 3/5 and planterflexion 4/5 of the right foot.

Right hemilaminectomy of L5 with foraminotomy of both L5 and S1 right side was performed. Meticulous cleaning of L4-5 was performed from the right and the foramen was checked for patency and redundancy for the running root. Inspection of the right S1 root revealed a mobile small extrusion compressing the root. This extruded piece was removed without violating the L5-S1 disc space.

Smooth postoperative recovery.

The patient before surgery had major problem at L4-5 level, which brought her to surgery. During surgery, the extruded small disc at L5-S1 was more convincing for her agonizing pain.
The L5-S1 disc space was not violated, so as to make the postoperative course more easier and to limit the inflammatory process in case of possible involvement in the future, considering that the patient is a known diabetic.