The patient was operated by me 30-August-2008 for PLD L4-5 with left downward migration. He was doing well until he came 12-March-2009 complaining of LBP with scoliotic stance. MRI performed 10-March-2009 showed small recurrence which was treated conservatively.

The patient then came 07-October-2009 claiming that he improved in 90% but still having scoliotic stance and left sciatica.

MRI lumbar spine performed 22-October-2009 showing huge extruded recurrent disc L4-5 with left downward migration.

On examination: the patient was neurologically free, but surgery was advised.

Refreshment of the left L5 root was achieved and the huge extruded disc was removed in several pieces intentionally to prevent root damage. Cleaning of the L4-5 disc space was performed and PEEK Satellite nucleus replacement sphere No 12 was inserted, which reduced the collapsed disc space to the previous normal height. All the stage were controlled using image-intensifier.

Routine closure of the wound and smooth postoperative recovery.

Insertion of PEEK Satellite nucleus replacement sphere in this case giving two advantages: preventing third recurrence and bring back acceptable alignment of the disc shape avoiding during that the stress in the L4-5 facets both sides.