The patient came to the clinic 25-April-2002 complaining of severe LBP with right sciatica for 2 years with exacerbation last 2 months. The patient is hypertensive for 3 months in treatment. He has bronchial asthma since 1999. MRI done recently showing extruded disc L3-4 with right far downward migrating calcified disc.

On examination: The patient is in agonizing pain. limping with exaggerated scoliotic stance. SLRS 50 degrees in the right with pain and 60 degrees in the left. There is drop right foot with weak planterflexion right foot 3/5. There is hypalgesia right L5 and S1 territories.

Laminectomy L4 and lower third of L3 with foraminotomy both L4 roots.  Bilateral cleaning of L3-4 disc space and the far downward migrating extrusion was removed from the right side just above the level of L4-5. Inspection for any extrusions and calcified extrusion, since the process was long-standing was considered and the bony fragments were removed. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot still the same and he was sent to the ward.

The patient the came to the clinic 09-May-2002  with clean wound and same weakness and SLRS 65 degrees with less pain.

The patient then came 05-June-2002 with SLRS 70 degrees without pain and improved dorsi and planterflexion right foot 4/5 with hypalgesia regressed to the right S1 territory. After that the patient disappeared.

There is an estimated postoperative recurrence around 7%, since the disc space is not shallow.

In retrospective analysis after 20 years of performed such surgery, this operation was long and the C-arm was of little help, because the patient is overweight and as seen in the video recording, no need for bilateral cleaning. The surgery must be planned for complete right hemilaminectomy and removal of the far downward migrating big piece must take precedence. (10-April-2021).