The patient  came to the clinic 03-May-2012 complaining of LBP with right agonizing sciatica for 6 days. MRI lumbar spine performed 02-May-2012 of bad quality with full of motion artifacts, showed extruded disc L4-5.

On examination, the patient is limping with exaggerated scoliotic stance with SLRS 70 degrees with pain in the right side. There is weak dorsiflexion right foot 3/5.

The patient was sent for new MRI lumbar spine with dynamic studies, which were done 05-May-2012 showing huge extruded disc L4-5 with right far upward migration.

The patient has sacralized L5. Right partial flavotomy L4-5 with extension upward. The far upward migrating huge extrusion was removed in two pieces, one anterior to the dural sac and one behind the sac just under the remaining lamina of L4. Right sided cleaning L4-5 disc space. The right L5 root hanging free. Check for remnant of extrusion revealed one small fragment anterior to the dural sac, which was removed accordingly.

Routine closure of the wound. Smooth postoperative recovery. The power of the right foot normalized.

The patient performed bad MRI in the start, which could be not candidate for surgery. The repeat of MRI with proper study, showed the very huge far upward migrating extrusion.

The estimated recurrence rate after surgery still ranking around 7%, because the disc space is still not shallow.