Objectives To investigate the clinical efficacy of unilateral MIS-TLIF and unilateral pedicle screw fixation in the treatment of extreme lateral lumbar disc herniation (FLLDH). Methods From June 2012 to March 2016, 37 patients with extreme lateral lumbar disc herniation (18 males and 19 females, aged 41-76 years, with an average age of (59.4± 8.8 years old) )were retrospectively analyzed. The operative segments were 11 cases in L3/4, 21 cases in L4/5, and 5 cases in L5/S1. The standard TLIF approach was used for foraminal FLLDH and the transverse process+partial superior articular process osteotomy was used for exterior foraminal FLLDH. The operation time, bleeding volume, incision length, hospitalization time and complications were recorded. The pain visual analogue scale (VAS), the Oswestry Disability Index (ODI) and imaging data of preoperative and postoperative were compared to evaluate the clinical efficacy.Results The operation was successfully completed in all cases. The operation time ranged from 70 to 130 minutes, with an average of (100.00±23.9) minutes. The amount of bleeding ranged from 80 to 150 ml, with an average of (100.00±32.9) ml. The length of incision was 3-6 cm, with an average of (4.0±1.2) cm. The hospitalization time ranging from 4 to 13 days ,with an average of (7.0±2.5) days,. The follow-up period ranged from 14 to 35 months, with an average of (22.1±4.8) months. The VAS scores of low back pain and leg pain, ODI of lumbar spine function in 1 month, 3 months, 6 months, 12 months and the last follow-up of postoperative were significantly improved compared with those preoperative (P < 0.05). Postoperative X-ray follow-up showed that the internal fixation was in good position. Postoperative CT follow-up showed that intervertebral bone fusion ranging from 9 to 15 months , with an average of (13.3±2.7) months. The intervertebral height was lost in 3 patients after operation, with a loss rate of 8.82%. There were no dural sac and nerve root injuries, no incision infection, internal fixation loosening, displacement, exfoliation and other complications.Conclusions Treatment of extreme lateral lumbar disc herniation with unilateral intervertebral foramen decompression, discectomy, nerve root decompression, Cage implantation, and unilateral pedicle screw fixation through posterior lumbar posterior minimally invasive Quadrant channel. It has the advantages of short operation time, less bleeding, less trauma, less complications and quick recovery. It is safe and effective minimally invasive method in the treatment of FLLDH.