The patient came to the clinic 17-July-2012 complaining of LBP for 2 years with left sciatica. She cannot walk more than 20 meters due to pain. The patient is known diabetic.

On examination, the patient is limping with exaggerated scoliotic stance. She has severe deformity of the left ankle joint. SLRS was 80 degrees in both sides. There is weak dorsi and planterflexion both feet 4/5. here is diabetic neuropathy with decreased sensation both feet .

The patient was sent for MRI investigation and done 23-July-2012 showing huge extruded disc L5-S1 with downward migration more to the right. Dynamic studies ruled out instability and the X-ray of the left ankle showed severe destruction of the bony structures.

Bilateral S1 foraminotomy with bilateral flavotomy. The extruded disc was calcified and severely compressing both roots. Drilling was used to remove the extrusion from both sides, until the roots became lax and free. The disc space was very shallow.

Routine closure of the wound. Smooth postoperative recovery. The power of both feet became better, more better in the right foot.

The patient have postoperative estimated recurrence below 7%, because the disc space height is shallow.

The patient later needs triple arthrodesis of the left ankle to regain more or less acceptable bony alignment.