The patient came to the clinic 29-August-2004 complaining of LBP with bilateral sciatica more the left since she was operated 4 years ago without improvement. MRI done the 24-August-2004 showed huge recurrent extruded disc L4-5 with left foraminal occlusion.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 85 degrees in the right  and 45 degrees in the left with pain. There is weak dorsi and planterflexion left foot 3/5 with hypalgesia left L5 and S1 territories.

Foraminotomy with neurolysis left L5 roots with removal of the huge extrusion lateral to the axilla from the left side. After that, the root became lax and left sided intradiscal cleaning L4-5 disc space was done. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A fat in pedicle was transferred from the subcutaneous layer and covered the exposed parts of the dura and roots to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the left foot became normal. She was sent to the ward.

The patient came to the clinic 09-Septmber-2004 with clean wound and SLRS 90 degrees both sides without pain and neurologically free.

The patient came 11-March-2006 complaining of LBP with left sciatica for 3 months and MRI done 01-February-2006 showing small fragment at the left foramen of L4-5 and she was advised for conservative treatment.

The estimated postoperative re-recurrence is still ranking around 7%, because the disc space is still relatively not shallow.