The patient was operated by me 16-September-2004 for PLD L5-S1 for left sciatica and had smooth postoperative course.

The patient then came 26-February-2005 complaining of LBP with right sciatica with SLRS 15 degrees in the right with preserved motor and sensation both lower limbs.

MRI lumbar spine performed 10-March-2005 showed huge central extruded disc L4-5. The patient was advised to undergo surgery but he escaped.

The patient then came 13-January-2009 with exacerbation of his LBP the last 15 days with bilateral sciatica. SLRS was 30 degrees in both sides with weak dorsi and planterflexion both feet 4/5 and hypalgesia right L5 and S1 territories.

New MRI performed 12-January-2008 showed the same extrusion.

Laminectomy of the residual lamina of L5 and partial of L4 was performed and using image intensifier the exact level of L4-5 was identified. Bilateral cleaning of L4-5 disc space was achieved and the huge extrusion was removed from the left side lateral to the axilla in one piece.  Routine closure of the wound.

Smooth postoperative recovery and the weakness of the both feet disappeared after surgery.

The patient has huge extrusion of L4-5 and he was planned for surgery 4 years ago. The new MRI showing a fresh fragment, which could be a new prolapse of the disc of L4-5.

The expected recurrence rate of this disc is around the average, since the disc space height is still not shallow.