The patient came to clinic 29-Sptember-2014 complaining of LBP with left sciatica for 5 years with exacerbation last 2 months and further deterioration last 20 days after physiotherapy. MRI lumbar spine done 19-July-2014 showing bulge L4-5 and extruded disc L5-S1 with left foraminal occlusion.

On examination; the patient is limping walking with aid and using crutches for with exaggerated scoliotic stance. SLRS 30 degrees with pain in the left and 75 degrees in the right. There is almost drop left foot.

MRI repeated today showing further enlargement of the L5-S1 extrusion with same bulge of L4-5.

Skeletonization of L5, upper sacrum and lower third of L4 laminae. There is recent fracture of the upper sacrum at its spinous process, for what C-arm was used to check level. Foraminotomy both S1 roots and left L5 root. Bilateral cleaning of the extruded disc L5-S1 with bilateral intradiscal cleaning of its space. Inspection of the extruded disc of L4-5 from the left showed old changes without mobile material, for what it was decided not to violate the disc material. Instead, good decompression of the root canal was achieved. Routine closure of the wound.

Smooth postoperative recovery. The power of the left foot became better.

The patient still has an estimated postoperative recurrence around 7%, because the disc space is still not completely shallow.

If both disci were violated then the recurrence rate would be around 30%.

The fractured elements of upper sacrum could not be figured by MRI.