The patient came to the emergency of Shmaisani hospital with agonizing LBP and right sciatica down to right L5 territory for 10 days, that he could not sleep during this period due to pain. The patient is a known diabetic for 2 years. He came 05-March-2013 to the clinic with same complains but with lesser degree of pain and MRI lumbar spine done 02-March-2013 showed bulge disc L4-5 and L5-S1 and the patient was treated conservatively and he improved. MRI lumbar spine done recently in 09-December-2013 showing extruded disc L4-5 with right up and downward migration.

On examination is limping, in agonizing pain with exaggerated scoliotic stance. SLRS was 80 degrees both sides without pain. There is almost drop right foot -3/5.

Using C-arm, the L4-5 level was identified and lower 2/3 of L4 and upper 1/3 of L5 laminae were drilled out with foraminotomy of right L5 root. The extruded disc was adherent to the axilla and it was removed with sharp dissection. The far upward migrating piece was near the axilla of the right L4 root. It was removed in one big piece. Inspection for any remnants was negative and the disc space of L4-5 was cleaned from the right. Routine closure of the wounds.

Smooth postoperative recovery. The power of the right foot became normal and the agonizing right sciatica disappeared.

The estimated postoperative recurrence of L4-5 is still around 7%, because the disc space is still not completely shallow.