The patient, an old client came to the clinic 28-March-2006 for neck pain and LBP several times and was treated conservatively. The patient then came 23-August-2012 complaining of agonizing left sciatica with LBP for a week. He has diabetes mellitus and arterial hypertension for the last three years.

MRI lumbar spine performed 22-August-2012 showing extruded huge disc L2-3 with left downward migration.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 30 degrees in the left with pain. There is weak all muscles left leg -4/5 and the dorsiflexion right foot 4/5.

Using image-intensifier, partial laminectomy L2 and L3 more to the left. The facet was hypertrophied and deformed, compressing the dural sac. Foraminotomy left L3 root. The extruded disc L2-3 was removed lateral to the axilla. Inspection under the axilla was negative.

Routine closure of the wound. Smooth postoperative recovery and the power of the affected limbs became normal.

The patient has huge extrusion at unusual level. This could happen after performing rotational movements under stress. The disc segment must be abnormal before the stress.

Postoperative recurrence still above 7%, because the disc space is still not shallow.