The patient came to the clinic 17-June-2012 complaining of LBP and right sciatica with almost drop right foot. The patient was operated in Syria March-2011 for PLD L4-5. He was doing well until the last 6 months start to deteriorate.

On examination, the patient is limping with exaggerated scoliotic stance with SLRS 60 degree with pain in the right and drop right foot and weak planterflexion 3/5 and hypalgesia right S1 territory.

New MRI was requested and done 18-June-2012 showing huge recurrence of L4-5 with right downward migration.

Scarolysis of the right side of the previous L4-5 exposed dura. Drilling of the right upper corner and foraminotomy of the right L5 root. The extruded disc is severely compressing the root from anterior and it is impossible to reach the extrusion from under the axilla. The disc space was reached lateral to the axilla and after meticulous cleaning of the disc space the extruded huge fragment was pushed to the disc space and removed in several big pieces. The root and the axilla became lax and further cleaning of the disc space was continued. Guardix-sol 1.5 ml was applied to minimize postoperative adhesions.

Routine closure of the wound. Smooth postoperative recovery with normalization of the power of the right foot.

The patient still have an estimated postoperative recurrence around 7%, because the disc space is still not shallow.