The patient a Bahraini citizen, was operated for PLD L4-5, L5-S1 30-July-2001. Then she came to the clinic 05-September-2002 complaining of neck and LBP with numbness left median distribution. MRI lumbar spine showing fragments of extrusion at L5-S1 left side. MRI cervical spine done 04-September-2002 showing bulge C2-3.

On examination: The patient in agonizing pain and limping with exaggerated scoliotic stance. There is weak grip both hands and neck pain when rotating the head to all directions. SLRS 80 degrees with pain in the left. There is severe weak dorsiflexion both feet 3/5 and planterflexion left foot 4/5.

She was sent for investigations and MRI brain was normal, cervical spine performed 11-Sptember-2002 showing bulge C2-3. Dynamic studies ruled out overmobility.

Extended left S1 foraminotomy with removal of the extrusion lateral to the axilla from the left. Left sided intradiscal cleaning L5-S1 with osteophytectomy, using drill. The lateral wall of the dura under the axilla where maximum traction was applied got  dural tear which was repaired by nylon 6 zero stitch. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot improved, the left the same. She was sent to the ward.

The patient came to the clinic 27-September-2002 with clean wound, SLRS 30 degrees right side with pain and 20 degrees with more pain in the left with still having weak dorsiflexion left foot 4/5.

There is still an estimated postoperative re-recurrence around 7%, because the disc space is still not shallow.