The patient was operated by me 11-March-2013 for huge recurrent extruded disc L3-4. The patient then came to the clinic 18-November-2013 complaining of left sciatica for the last 4 months.

On examination: the patient is not limping without scoliotic stance. SLRS was 80 degrees both sides with pain in the right. There is no motor or sensory deficit. MRI lumbar spine done the same day and recurrent huge extruded disc L3-4 with left foraminal occlusion was noted.

Using C-arm, the L3-4 level was identified. The old wound refreshed and dissection was mainly done from the left side to avoid the previous CSF leak which happened from the right side. Slight drilling of the left L3-4 medial wall of the L3-4 facet. The L3-4 disc space another time confirmed. All the area is full of scar, that only the lateral wall of the dura could be seen at limited area in the target working zone. The extruded disc was removed in several pieces. Part of it was adherent to the posterior wall of the dura. All attempts were paid to avoid dural tear in this area. Left sided intradiscal cleaning of L3-4 disc space. Routine closure of the wound.

Smooth postoperative recovery. The left sciatica decreased.

The estimated postoperative third recurrence of L3-4 is still around 7%, because the disc space is still not completely shallow.

It could be, when performing postoperative MRI, the space of the previous extrusion will be seen as recurrence, because the dural structures and the scars will not collapse. MRI will be requested upon the follow up.