The patient  came to the clinic 28-March-2012 complaining of LBP with left sciatica for 3 years with intermittent course. She got exacerbation the last 25 days with severe escalation the last 3 days with numbness of the left S1 territory.

MRI lumbar spine performed 08-March-2012 showing extruded disc L5-S1 with left foraminal and downward migration with bulge L4-5.

On examination, the patient in agonizing pain with exaggerated scoliotic stance. SLRS was 50 degrees in the right and 5 degrees in the left with shooting pain. The left AJ is absent. There is profound weakness left foot dorsi and planterflexion 3/5. There is hypalgesia left L5  and analgesia left S1 territories.

The left border of the L5-S1 of flavum was released and reflected to the right. Foraminotomy of the left S1 root. The extruded disc was removed lateral to the axilla. Meticulous left sided cleaning of L5-S1 disc space. Inspection of the root, showed presence of disc material adherent to it. It was released from the root completely so as to avoid postoperative MRI false interpretation, as be the disc was not removed. The root is hanging free. The epidural fat was shifted to the root. The flavum was returned it its original state.

Routine closure of the wound. Smooth postoperative recovery. The power of the left foot became normal.

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

Reflection of the flavum and preserving it, minimize postoperative fibrosis.

Removal of the adherent disc material, prevent postoperative fault interpretation of the presence of recurrence.