The patient came to the clinic 25-December-2008 complaining of LBP and bilateral sciatica which took place 18 months after performing discectomy L4-5  2003 elsewhere.

On examination: the patient  has exaggerated scoliotic stance. SLRS was 20 degrees both sides with agonizing pain and she cannot sleep supine. She had weak dorsi and planterflexion both feet 4/5 with numbness all toes both feet.

MRI of the lumbar spine with MRMyelography was performed 06-September-2008 showing huge recurrent disc L4-5 left side.

Considering that the patient pain increased in the right side after the performed MRI another MRI was requested and done 25-December-2008.

The patient is a known diabetic and hypertensive and under treatment with Imuran for hypertrophic glomerulonephritis for 6 months. Stinting of the coronary artery was performed 1 month ago.

The patient was admitted one day before surgery and mega doses of Vit C and multivitamins were given to avoid possible wound dehiscence after surgery.

Using image-intensifier, the L4-5 level was identified and drilling of the upper left corner of the bony defect was performed. There was a lot of adhesion and the disc space was reached lateral to the left L5 root axilla. Cleaning of L4-5 was performed. after what the calcified extruded disc was removed in several pieces. There was a lot of adhesion around the root and trying to minimize the scar was achieved. Routine closure of the wound with water-tight multilayer stitching.

Smooth postoperative recovery and the power of both feet normalized.

Recurrence still a dilemma, which needs proper solution in lumbar disc surgery. The patient had signs of recurrence 6 years without improvement.

The expected recurrence rate in this case is still around the average, because the disc space height still not shallow.

In case of recurrence and adhesions, it is mandatory to look for dural defects and tears, so as to manage them properly.