The patient came to the clinic 10-November-2009 from YAR complaining of LBP with bilateral sciatica for 2 years with exacerbation of left sciatica the last week.

The patient has squint left eye since childhood. He was limping with exaggerated scoliotic stance. He had parahypalgesia below D9 both sides with SLRS 40 degrees in the right and 70 degrees in the left. He had weak dorsiflexion both feet 4/5 right and 3/4 left side and planterflexion left foot 4/5. Both quadriceps femori power 4/5.

MRI dorsal spine performed 10-November-2009 showing old deformity of the upper dorsal spine with malacia of the spinal cord at the d6-7 level. MRI lumbar spine showing severe lumbar canal stenosis L3-4 and L4-5 with extruded disc L3-4 more to the left.

Skeletonization of L3 and L4 laminae was performed and laminectomy of L4 and partial of L3 was done.  There is no epidural fat due to severe compression. Using image-intensifier during all steps of surgery the level of L3-4 was confirmed and the extruded disc was removed lateral to the axilla of left L4 root. Meticulous cleaning of the disc space of L3-4 was achieved from the left.

PEEK Satellite nucleus replacement sphere No 13 was inserted and check in AP and lateral views was done confirming acceptable position of the device.

Routine closure of the wound and smooth postoperative recovery and improvement of the power of both feet.

Recurrence of disc prolapse is around 15% in this case because the disc space is still high and the defect of the annulus fibrosis is wide.

To minimize this to 2% PEEK Satellite nucleus replacement sphere was applied.