The patient came to the clinic 09-November-2008 complaining of right sciatica for one year. Exacerbation of the same sciatica since 06-October-2008 after lifting heavy object.

The patient underwent discectomy L2-3 for left sciatica 2001 elsewhere.

On examination: the patient is limping with agonizing pain with exaggerated scoliotic stance, with SLRS 40 degrees in the right and 45 degrees in the left shooting to right with weak planterflexion and dorsiflexion 4/5 right foot.

MRI lumbar spine performed 11-November-2008 ruling out recurrence and confirming the de novo extrusion of L3-4 causing segmental stenosis at this level.

Skeletonization of L3 and L4 laminae, using image-intensifier. Laminectomy of L3 was performed and the upper edge of L4 with foraminotomy of right L4 root. The extruded disc was removed and cleaning of the L3-4 disc space was performed from the right.

Smooth recovery with prompt improvement of the power of right foot.

The patient was operated 7 years ago and dissection of many level was performed even the level of L1-2, leaving a lot of scar with long skin incision. Using image-intensifier, not only minimize the operative time, but it is also necessary to prevent the wrong level.

All these elements must be corrected during surgery. The segmental stenosis was resolved and the extruded disc was removed and the stenotic foramen of right L4 root was widened.

The estimated recurrence rate in this case is below 7%, because the disc space was shallow.