The patient came to the emergency of Shmaisani hospital 22-August-2010 complaining of agonizing right sciatica for one week. The patient was complaining of difficult walking for several years with intermittent claudication. She was operated by me for PLD L5-S1 15 years ago.

MRI lumbar spine performed 21-August-2010 showing extruded disc L4-5 with right far downward migration and lumbar canal stenosis L2-3 and L3-4.

On examination: the patient is unable to stand and cannot lay supine for examination. SLRS was 20 degrees in the right with pain with almost drop right foot and analgesia right L5 and S1 root.

Decompressive laminectomy L2-3-4 and scarolysis at the level of previously removed L5 lamina. The dura was very thin with mesh-like perforations of the dura which were repaired by nylon 6 zero. Foraminotomy of right L5 root was achieved. The lateral wall of the root was also with dural defect, which was also repaired. The far extruded disc was removed from under the axilla in several fragments, after what the root was free of compression. The shallow disc space of L4-5 was approached lateral to the axilla and the disc space was cleaned from the right. The head was positioned up and Valsalva maneuver was applied to check for CSF leak. It was negative. Two pieces of muscles were applied over the dural defects to further insure the avoidance of postoperative CSF leak.

Routine closure of the wound and smooth postoperative recovery with improvement of the power of the right foot and disappearance of right sciatica.

The estimated postoperative recurrence rate in this case is around minimal because the disc space height is very shallow.

The extruded disc was far migrating down and separated from the disc space and it was necessary to remove it from under the scarrous right L5 axilla.