The patient was operated elsewhere 20-February-2008 for PLD L4-5 for left sciatica and continued to complain of the same sciatica after surgery.

The patient came 29-December-2008 complaining of LBP with left sciatica with SLRS 10 degrees in the right and 20 degrees in the left with weak dorsiflexion left foot -4/5 and planterflexion 4/5 with hypalgesia left L5 and S1 territories.

MRI lumbar spine performed 18-May-2008 showed huge recurrence at L4-5 left side with left foraminal occlusion, but the report was interpreting it as massive fibrosis. The patient was limping with exaggerated scoliotic stance.

New MRI performed 24-December-2008 showed the same extrusion.

Scarolysis of the left L5 root was performed and drilling was achieved, so the the extruded disc was identified. The extruded disc was removed lateral to the axilla and meticulous cleaning of L4-5 disc space was performed from the left side.  Routine closure of the wound.

Smooth postoperative recovery and the weakness of the left foot disappeared after surgery.

The patient has huge extrusion of L4-5 and the first MRI showed the presence of the recurrence, but the radiologic report interpreted it as massive fibrosis. After all surgeries the fibrosis is a normal phenomenon and it is by no means the cause of the agonizing pain.

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

Key-hole surgery is not preferable standard, if the surgery is not resolving all the problems of the patient. From the same previous incision, foraminotomy of left L5 root was performed and drilling of the medial wall of the lateral mass was extended, so as to reach the disc level and perform removal of the extrusion and meticulous cleaning.