The patient a doctor, came to the clinic 19-July2003 complaining of LBP for 5 years with right sciatica for 6 months. MRI done 20-March-2004 showed huge extruded disc L4-5 with right downward migration.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 50 degrees in the right  and 80 degrees in the left with pain. There is weak dorsiflexion right foot 3/5 with hypalgesia right L5 and S1 territories.

Foraminotomy right L5 roots with removal of the huge extrusion lateral to the axilla from the right side. After that, the root became lax and right sided intradiscal cleaning L4-5 disc space was done. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A fat in pedicle was transferred from the subcutaneous layer and covered the exposed parts of the dura and roots to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the right foot became normal. He was sent to the ward.

The patient came to the clinic 05-Septmber-2004 with clean wound and SLRS 80 degrees both sides without pain and neurologically free.

The patient came 08-April-2017 complaining of LBP with right sciatica for 1 month and neurologically he was free. He was sent for MRI lumbar spine and done 09-April-2017 showing small recurrence at L4-5. He was treated conservatively and improved.

The estimated postoperative recurrence is still ranking around 7%, because the disc space is still relatively not shallow.