The The patient came to the clinic 07-December-2004 complaining of LBP for 4 years with right sciatica. The patient is a known diabetic for 9 years.

On examination: The patient is left handed with Hoffmann positive in the right with weak grip and extension of the right hand and right triceps muscle. The patient was limping and with SLRS 45 degrees in the right with weak right foot. MRI of the brain, cervical and lumbar spine were requested, but the patient escaped.

The patient then came to the emergency of Al-Shmaisani hospital 19-January-2007 with agonizing right sciatica. He had exacerbation of right sciatica the last 3 months. He was unable to sleep the last week. MRI of the lumbar spine was requested and done 21-January-2007, showing a huge extrusion of L4-5 disc with right downward migration.

On examination, the patient was unable to walk and drop right foot with hypalgesia of the right L5,S1 roots.

Right L5 foraminotomy with right L4-5 hemiflavotomy was performed and the downward migrating disc was removed from under the axilla in several pieces. The root became free, but it is swollen. The root was shifted medially and the the disc space was cleaned from the sequestrated intradiscal material. Moderate amount was removed. The epidural fat was shifted to cover the root, to minimize the scar formation.

Smooth postoperative recovery and the power of the right foot became normal.

Minimal cleaning of the intradiscal space proved to heighten the incidence of recurrence, so that, it is preferable to perform intradiscal cleaning of the sequestered material inside the disc space, after removing the extrusion.

Epidural fat local transfer is the best solution to prevent scar formation at the root trajectory. This maneuver decrease the postoperative pain suffering.

The disc space of this patient is not narrow and the cleaning was performed moderately and the defect in the annulus fibrosis was minimal, which could predict a lower than 7% recurrence rate.