The patient was operated by me 11-March-2015 for huge extrusion L4-5 with left downward migration. The patient then came 21-March-2015 with improvement and sent home. The patient then came 25-March-2015 telling that after shower got a generalized rash with severe LBP and fever without sciatica. After interrogation about the medication, it seems that he was receiving Augmentin 625 mg once a day after surgery. All medications were stopped and Zinnat 500 1x2 started and sent for lab investigations. WBC was 11.8, ESR 57 mm/h and CRP 18 mg/L. The patient then came 31-March-2015 with LBP without sciatica with no rash. SLRS was 40 degrees with pain in the left. There is weak dorsiflexion left foot 4/5. The patient was sent for MRI  and Lab investigations, which were done 31-March-2015 showing discitis with huge recurrence with left upward migration.

The old incision refreshed. There is no pus in the field. Foraminotomy left L4 root. The swollen friable extruded disc was removed until the axilla of the left L4 root was seen. Further cleaning of the intradiscal swollen disc material. Subaxillary inspection of the left L5 root.  Routine closure of the wound.

Smooth postoperative recovery. The power of left foot became normal.

The patient still has an estimated postoperative recurrence around 7%.

MRI after surgery most of the time is misleading. There was no pus in the field and the recurrence was full of swollen disc fragments.

It is better to explore the area instead of loosing a protracted period of time guessing what actually is going inside.