The patient came to the clinic 07-March-2007 complaining of LBP for 15 years without sciatica. The last 2 weeks got exacerbation of LBP with left sciatica. The patient is a known diabetic for 5 years with hypertension for 10 years.

MRI lumbar spine performed 05-March-2007 showing huge extrusion of L3-4 with up and downward extension left side.

On examination: the patient is limping with scoliotic stance with urgency and frequency of urination. SLRS was 50 degrees in the right and 20 degrees with shooting pain in the left. Complete drop left foot with weak dorsiflexion right foot 4/5 and left foot 3/5. Sensory los of the mid third and below the right forelimb and above knee of the left lower limb.

Partial decompressive laminectomy of L3 and 4 with foraminotomy for L4 and L5 roots both sides was achieved and all the compressive elements were eliminated. The extruded fragment was from the left facet joint and was severely compressing the left L4 root at the root canal level. Inspection of the L3-4 disc space was negative for presence of any extrusion from the disc, for what it was decided not to violate it.

Routine closure of the wound and smooth postoperative recovery with improvement of the motor power both feet.
 

It happens that, misreading of the MRI can lead to disturbances in planning of surgery. Surgery was needed in all situations, but the surgeon must consider any variations or possibilities and to be open-minded for all possibilities.