The patient came to the clinic 22-November-2010 complaining of right sciatica down to the ankle for two month. The patient was operated by me 1998 for huge PLD L4-5 with right downward migration.

MRI lumbar spine performed 31-October-2010 showing recurrent PLD L4-5 with right foraminal compression.

On examination: The patient  is in pain, limping with exaggerated scoliotic stance. There is weak dorsi and planterflexion right foot 4/5 with SLRS 80 degrees with pain in the right.

Using image-intensifier, foraminotomy of right L1 root was performed. The extruded disc was attacked lateral to the axilla and it was removed in several pieces, after what the root became lax. Meticulous cleaning of the disc space of L4-5 was achieved from the right.

Routine closure of the wound. Smooth postoperative recovery and improvement of the power of right foot.

The patient has persistent recurrent extrusion with dark gray extrusion of L4-5 level, which will not resolve over the time. Surgical decompression is the only solution.

Usually the recurrence take place at the same side of previous extrusion.

The estimated recurrence rate is still around 7% because the disc space is not shallow, despite the fact meticulous cleaning was performed from one side twice.