The patient came to the clinic 09-December-2012 complaining of LBP for 2 months with left sciatica for 1 week. The patient was operated 2002 for extruded disc L4-5 and 2006 for extruded disc L5-S1 elsewhere. Cath and stinting was applied 7 years ago.

On examination: The patient was limping with exaggerated scoliotic stance. SLRS was 85 degrees with pain in the left. Weak dorsiflexion right foot -4/5. There was hypalgesia left L5 root.

MRI lumbar spine done 27-December-2012 showed huge recurrent extruded disc L4-5 with left foraminal occlusion. The patient was advised to undergo surgery, but he escaped.

The patient then came 27-June-2013 telling that he dramatically deteriorated the last month with agonizing left sciatica. MRI of the lumbar spine done 26-June-2013 showing the huge extrusion of L4-5 still occluding the left foramen. SLRS was 70 degrees in the left with pain and weak dorsiflexion left foot -4/5 and planterflexion 4/5 with hypalgesia left L5 and S1 territories.

Exposure of the left L5 root and scarolysis. There was a pin point dural defect which was closed by 6 zero nylon. The huge extruded disc L4-5 was removed lateral to the axilla, after which the root became lax. Left sided intradiscal cleaning of L4-5 disc space.

Routine closure of the wound. Smooth postoperative recovery. The power of left foot became normal.

The patient still has an estimated postoperative recurrence below 7%, because the disc space is  shallow but not completely.