The patient was seen by me 08-October-2006 for LBP and right sciatica down to L5 territory with MRI of the lumbar spine done 17-September-2006 demonstrating slight extruded disc L5-S1, which was treated conservatively.

The patient came to the emergency of Al-Shmaisani hospital 30-May-2008 complaining of LBP with agonizing right sciatica for 3 days. Exacerbation of sciatica the last 3 days with limping and difficult walking and positive cough sign.

MRI lumbar spine performed 30-May-2008 showed extruded disc L5-S1 with right downward migration.

On examination: the patient in agonizing pain with exaggerated scoliotic stance and inability to walk. SLRS was 25 degrees in the left with pain and 5 degrees in the right. There was weak dorsi and planterflexion right foot 3/5, hypalgesia right L5 and S1 roots territory with absent AJ right side.

Right L5-S1 hemiflavotomy with foraminotomy of right S1 root was performed. The extruded disc was removed from under the axilla. Meticulous cleaning of the disc space from the right side. Inspection under the axilla and the foramen for remnants.

The epidural fat was kept untouched through the operation.

Routine closure of the wound with prompt recovery of the power of left foot.

The recurrence rate is above 7% in this case, because the disc space still not shallow and the defect in the annulus fibrosis is medium in size.

Preserving the epidural fat minimize the incidence of postoperative fibrosis.