The patient came to the clinic 18-April-2018 complaining of LBP for 8 years with left sciatica for 2 years with exacerbation of left sciatica the last month. At that time there was weak dorsiflexion left foot with SLRS left side 70 degrees with pain. The patient was sent for investigations and MRI lumbar spine done 07-May-2018 showed extruded disc L4-5 with left downward migration. The patient was advised for surgery, but for financial reasons he disappeared. The patient then came 03-September-2020 urging for surgery due to severe exacerbation of his left sciatica the last 5 months.

On examination: The patient is not limping with exaggerated scoliotic stance. There is weak dorsiflexion left foot -3/5 with hypalgesia of the left L5 territory and analgesia of the left S1 territory. SLRS was 30 degrees with pain left side.

The patient was sent for investigations and MRI lumbar spine performed the same day showing the same extrusion of L4-5 with left downward migration.

Extended left L5 foraminotomy with removal of the extrusion and left sided intradiscal cleaning of L4-5.  MultiGen was not used to shorten the operative time due to Covid-19 and financial reasons. 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 left foot improved. He was sent to the ward.

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