The patient came to the hospital 08-June-2008 with agonizing bilateral sciatica for three months more the left. He was operated 2006 for PLD L5-S1 for the same sciatica.

MRI lumbar spine performed 29-May-2008 showing very huge recurrence at L5-S1 more to the left.

On examination: the patient has weak dorsiflexion both feet 4/5 right and -4/5 left, and planterflexion left foot 4/5, with hypalgesia of the left lower limb above the knee joint.

The patient is known diabetic, under treatment with Mixtard 25 and 35 units daily.

Interestingly, the old scar was perpendicular to the midline. A midline incision was performed, ignoring the old one.

Left L5-S1 hemiflavotomy with foraminotomy of left S1 root was performed. The extruded disc was removed lateral to the axilla. The scar was removed along the root and superior to the axilla, since the major part of the extrusion was upward. It was necessary to approach the upward migrating part through isolated route. Meticulous cleaning of the disc space from the left side.

Smooth postoperative recovery and normalization of the power of both feet.

The recurrence rate in this case is lower than the average, because the disc space height is minimal.

Recurrent disc leave scar, for what dissection must be started from the healthy tissues.

Good imagination of the extrusion must be kept in mind so as not to miss the extrusion, as in this case. It was necessary to perform isolated surgical route to remove the upward migrating big piece.