The patient came to the clinic 11-November-2007 with left sciatica and LBP for 45 days.

The patient was limping with scoliotic stance with MRI of the lumbar spine performed showing extruded disc L5-S1 with left downward migration.

On examination: the SLRS was 20 degrees in the left with weak dorsiflexion left foot 3/5. Hypalgesia of the left L5 and S1 root was noted.

The patient was given medications and if he is not improving, then surgical treatment will be the alternative.

Exacerbation of the left sciatica the last three days and the patient came to the emergency of Al-Shmaisani Hospital with almost drop left foot wand numbness of the left foot.

Left L5-S1 hemiflavotomy was performed and left S1 foraminotomy was done. The extruded disc material was impossible to remove lateral to the axilla. It was pushing the nerve laterally.

The down migrating disc material was removed from under the axilla, after what it was possible to shift the root medially and meticulous cleaning of the disc space of L5-S1 was done from the left. The epidural fat was transferred to the naked root.

Routine closure of the wound and smooth postoperative recovery with normalization of the power of the right foot.

Foraminotomy of the involved root must be done in all disc surgeries to be sure that there is no remnant left under the axilla.

The extruded disc during surgery was more huge than in the MRI. It could be due to improper pictures obtained during MRI, or progression of the extrusion.

The disc height is shallow, which decrease the expected recurrence rate.