The patient was operated elsewhere 04-August-2009 for right sciatica for PLD L4-5 which was complicated with infection and recurrence with agonizing right sciatica. The patient was operated another time 27-August-2009 after what further deterioration with drop of the right foot took place.

MRI lumbar spine performed 03-September-2009 showing huge recurrence of L4-5 with still having infection of the wound.

On examination: the patient is bedridden and unable to walk due to agonizing right sciatica. SLRS was 40 degrees in the right with pain with complete drop right foot and weak planterflexion right foot 4/5 and analgesia of right L5 root and hypalgesia of right S1 root.

The wound was refreshed  and the pus was sent for Bac-Tec. Right L5 foraminotomy with the use of imageintensifier and the extruded disc was removed lateral to the axilla in several pieces. Meticulous cleaning of the disc space of L4-5 was achieved from the right. The old scar tissue was removed to inspect the axilla so as not to miss migrating material down the axilla. Inspection of the root in the foramen was negative. Debridement of the wound with removal of all infected tissues.

Routine closure of the wound and smooth postoperative recovery and the patient sent to the ward.

The patient was operated twice by fenestration. Using this approach is not ideal, since you cannot identify the root and explore the axilla. It was necessary to extend the flavotomy up and down to see all the involved structures.

PEEK satellite sphere cannot be used in this case, because it could trigger the infection.