The patient came 14-August-2006 complaining of LBP for 1 month
with left sciatica for 12 days. The patient was operated by me 16
years ago for PLD L5-S1 16 years ago. MRI performed 17-July-2006
showed no recurrence.
On examination: the patient is limping with agonizing pain and
cannot set on the chair with SLRS 5 degrees in the left
with absent Achill's reflex left side. weak planterflexion and
almost drop left foot with hypalgesia left L5 and S1 territories.
The patient was sent to another MRI and performed 17-August-2006
, which confirmed recurrence at the site of the previous surgery
from the left side.
Left S1 foraminotomy was done and the root was followed upward
with minimal scar until the extrusion was seen severely compressing
the nerve. It was impossible to elevate the root off the
compression, for what it was decided to clean the intradiscal space
and to push the extrusion to the disc space and from there to remove
it. After that the root became lax and soft. Inspection of the
axilla was negative.
The previously inserted fat graft in pedicle was bisected in 2
layers and reflected to cover the exposed root to minimize scar
1. The patient was operated 16 years ago, when it was a common
practice, to cover the dura with fat graft with pedicle, reflected
to cover the dura and roots. Here is an example of good-looking fat
inserted 16 years ago with good result. The fat was so soft,
but a little harder than the epidural fat, but it provided the
intended function from this maneuver . i.e., prevent scar formation
and give elasticity to the neural structures, minimizing
2. It is the first case in my series of recurrence with this long
protracted period (16 years) of time. The patient was in good
condition all the time, but after lifting heavy object she started
3. Do not hesitate to ask for new MRI, if the recently performed one
not conforming with the clinical data. It happens, that the disc can
change configuration within seconds, not speaking about days or