The patient was operated by me 07-March-2004 for PCD C5-6 and C6-7 with fusion. Then he came 11-July telling that after lifting heavy object start to complaining of LBP with bilateral sciatica more the right sciatica.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 0 degrees in the left with pain. There is weak dorsi and planterflexion both feet 3/5 more weak in the left, with hypalgesia left L5 and S1 territories.

The patient was sent for investigations and MRI lumbar spine performed 18-July-2004 showing huge extruded disc L4-5 more to the left side.

Foraminotomy left L5 root with removal of the huge extrusion lateral to the axilla. 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. He was sent to the ward.

The patient came to the clinic 10-August-2004 with clean wound and SLRS 90 degrees both sides without pain and normal power of the left foot  with hypalgesia left L5 root.

The patient then came several times concerning his neck problems, but he came 15-June-2009 telling that after physical effort 2 months ago got LBP with bilateral sciatica more the left. MRI lumbar spine done 14-June-2009 showing recurrence of L4-5, more to the left and advised to undergo surgery and given medications.

The patient did not perform surgery and came 27-February-2011 telling that his condition is intermittent with improvement and deterioration. He was sent for investigations, but he disappeared.

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