The patient came to the clinic 01-November-2003 telling that she underwent surgery for PLD L3-4 for right sciatica in 28-July-2003. After operation started to complaining of LBP with numbness left lower limb. She is hypertensive for 2 years in treatment. Using walker after operation. MRI lumbar spine done 27-July-2003 showing extruded disc L3-4 with downward migration.

On examination: the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 90 degrees right side with pain. There is weak dorsi and planterflexion both feet, more the right with hypalgesia L5 and S1 both feet. The is also weak quadriceps both lower limbs

The patient was sent for new investigations and MRI performed 05-November-2003 showing extruded disc L3-4 with unstable fracture at this level. Dynamic studies showing recent fracture of the L4 body with instability.

Decompressive laminectomy L3-4. Foraminotomy both L4 roots was achieved. The first big piece was removed lateral to the right L4 root. The extruded disc material of L3-4 was removed from the right side with bilateral intradiscal cleaning L3-4 was achieved. Using bended Luque rectangle fusion of L5,4,2,1 was obtained with sublaminar wires. 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 feet showed mild improvement.

The patient's relative came to the clinic 17-December-2003 with check X-ray showing good alignment of the construct.

The patient then came 13-January-2004 with walker with no motor, nor sensory deficit and check X-ray showing good alignment of the construct.

There is still an estimated postoperative recurrence is zero because the area was fused.