The patient came to the clinic 22-January-2000 complaining of left shoulder and chest pain for 45 days. MRI cervical spine performed 27-December-1999 showing central disc C6-7. EMG done demonstrating moderate bilateral CTS, more the left hand. She came several times and in 20-March-2000 with complain of exacerbation of neck pain with weak left triceps muscle with MRI done 23-January-2000 showing with extruded disc C5-6 and wide based extrusion of C6-7. She was operated by me 21-March-2000 with discectomy C5-6, 6-7 and came to the clinic 28-March-2000 with clean wound with improvement of the power of the left upper limb and regression of the neck pain. The patient then came 26-August-2003 complaining of LBP and bilateral sciatica for 6 months with inability to walk more than 400 meters. SLRS was 80 degrees both sides with pain with weak dorsiflexion both feet 4/5. She was limping with exaggerated scoliotic stance. The patient was sent for investigations and MRI lumbar spine performed 09-September-2003 showing extruded disc L3-4 wide-based with bulge L4-5. She was advised for conservative treatment, but came 08-February-2004 complaining of exacerbation of LBP with bilateral sciatica more the left.

On examination: The patient is still limping with exaggerated scoliotic stance. SLRS was 60 degrees in the right with pain and 45 degrees in the left with more pain. There is weak dorsiflexion both feet and planterflexion left foot 4/5 with hypalgesia left L5 territory.

Decompressive L3-4 laminectomy. Bilateral L4 foraminotomy with removal of the extrusion lateral to the axilla from both sides. After that, the roots became lax and bilateral intradiscal cleaning L3-4 disc space was done. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A free fat was harvested from the subcutaneous layer and covered the exposed parts of the root. to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the feet improved.

The patient came to the clinic 22-February-2004 with clean wound and SLRS 85 degrees both sides without pain and no motor, nor sensory deficit.

The patient then came 07-December-2010 complaining of left shoulder. chest and left upper limb pain. The power of the left upper limb was normal, but had frozen left shoulder with edema of the left forelimb. The patient given medications and sent for investigations but she disappeared.

The estimated postoperative recurrence is still ranking around 7%, because the disc space is still relatively shallow.