The patient came to the clinic 21-November-2010 complaining of right sciatica and numbness of right L4 and S1 territories for one month. The patient was operated by me 16-September-2004 for huge PLD L5-S1 left downward migration. The patient then came 18-January-2009 complaining of bilateral sciatica for 15 days. MRI lumbar spine performed 12-January-2009 showing huge extrusion of L4-5 more to the left. He was operated by me 15-January-2009 .

MRI lumbar spine performed 20-November-2010 showing the extruded disc L5-S1 with right foraminal occlusion.

On examination: The patient  is in pain with exaggerated scoliotic stance. There is weak dorsi and planterflexion right foot 4/5 with SLRS 20 degrees with pain in the right, hypalgesia right L5 and S1 territories..

Using image-intensifier, foraminotomy of right S1 root was performed. The extruded disc was attacked lateral to the axilla and it was removed in several pieces, after what the root became lax. Meticulous cleaning of the disc space of L5-S1 was achieved from the right.

Routine closure of the wound. Smooth postoperative recovery and improvement of the power of right foot.

The patient has persistent recurrent extrusion with dark gray extrusion of L5-S1 level, which will not resolve over the time. Surgical decompression is the only solution.

The patient underwent enzymotherapy, after what his condition further deteriorated.

Usually the recurrence take place at the same side of previous extrusion, but this case is rare in that, it took place from the other side.

The estimated recurrence rate is still around 7% because the disc space is not shallow, despite the fact meticulous cleaning was performed from one side.