The patient came to the clinic 24-September-2009 complaining of LBP for 9 days with left sciatica for 5 days. MRI lumbar spine performed 24-September-2009 showing extruded disc L5-S1 with left downward migration.

The patient was limping with exaggerated scoliotic stance with shooting left sciatica. SLRS was 30 degrees in left side with pain. The patient had weak dorsi and planterflexion left foot 3/5 and analgesia of the left S1 root and hypalgesia of left L5 root.

Left S1 foraminotomy was done with reflection of the ligamentum flavum to the right. The extruded disc was seen under the axilla and it was pushing the root lateral. It was removed in several pieces so as to avoid further damage to the root. Inspection of the root showed that the dura of the medial wall of the root was damaged and CSF was coming out. It was repaired with Nylon 6 zero.

The root was shifted medially and meticulous cleaning of the L5-S1 disc space was performed lateral to the axilla. PEEK satellite nucleus replacement sphere 11 mm size was inserted and pushed at the center of the space with image intensifier.

Routine closure of the wound and smooth postoperative recovery and the power of the left foot normalized and the patient sent to the ward.

The disc space is still high and the patient is young, for what PEEK sphere was inserted to minimize the rate of postoperative recurrence.

The dura was torn by the extruded disc which was seen under the axilla and pushed posteriorly. It was damaging the dura at this location an it was repaired accordingly.