The patient came to the clinic 27-January-2008 with agonizing right sciatica and LBP for 10 days with positive cough sign. He is using crutches for ambulation and unable to sleep due to pain.

MRI performed 26-January-2008 showing bulge L4-5 and dehydration of D12-L1 with huge extrusion of L3-4 with right upward migration and right far-lateral disc occluding the foramen.

On examination: the patient is limping and has scoliotic stance. SLRS was 25 degrees in the right and 45 degrees in the left with radiating pain to the right leg. The patient had weak dorsiflexion right foot and weak quadriceps femoris right.

Using image-intensifier, the level was identified and right L3-4 hemiflavotomy with partial right hemilaminectomy was performed.

The upward migrating piece was removed and the far-lateral disc material was also removed, which were in continuity.

Meticulous cleaning of the disc space of L3-4 from the right. The epidural fat was transferred to the L4 root.

Routine closure of the wound and smooth postoperative recovery.

The disc height still considerable and the defect of the annulus fibrosis is wide. This make the expected rate of recurrence higher than average.

The far-lateral localization of the extrusion could mask the recurrence in case of its occurrence and clinically could be unnoticed.