The patient came to the clinic 23-August-2008 complaining of right sciatica for 2 years. The patient was operated for left sciatica 7 years ago and discectomy of L5-S1 was done at that time.

MRI lumbar spine done 24-August-2008 showing small extrusion of L5-S1 right side and fibrosis in the left side. He was advised to keep in conservative treatment.

The patient the last time  came 24-February-2010 complaining of left sciatica for 4 months with MRI of the lumbar spine the same day showing lateral recess syndrome L4-5 left side with the extruded old extrusion L5-S1 left side.

The patient is limping when in pain with exaggerated scoliotic stance and weak dorsiflexion left foot -4/5.

Left L5 root foraminotomy with left L4-5 hemiflavotomy was performed. Inspection of the left S1 root, showed extruded disc L5-S1 with severe compression of the root. The extruded disc was removed under the axilla and left sided cleaning of the disc space was achieved. The extrusion was rubbery hard and adherent with root and it was separated with great care to avoid traumatic injury to the left S1 root.

Routine closure of the wound.

Smooth postoperative recovery, and the power of left foot normalized.

MRI still not informative to tell exactly what is going on. The MRI was 1.5 tesla and Siemens with good quality. Despite that, it is possible to get misinterpretation about the morphologic data  and the real answer would be during surgery. In the near future we will use 3 tesla Verio Siemens  and see if these misinterpretations could be resolved.

In case you are suspecting two causes of the problem, check for them both, so as to avoid wrong plan of surgery.