The patient came to the clinic 17-August-2009 with LBP for several years and bilateral sciatica. Exacerbation of right sciatica the last 2 months . MRI lumbar spine performed 12-August-2009 showing lumbar canal stenosis L3-4 and L4-5 with extruded disc L3-4 with right downward migration.

On examination the patient has almost drop right foot with weak dorsiflexion left foot 3/5 and planterflexion right foot 3/5 with hypalgesia right L5 and S1 roots. SLRS was 70 degrees in the right with pain. The patient was limping with exaggerated scoliotic stance.

Laminectomy of L4 with partial of L3 and L5 to decompress the stenotic canal. Inspection of the right L4 root showed very huge extruded disc, which was migrating downward. It was removed in several pieces. Meticulous cleaning of the disc space of L3-4 from the right. The trail of 12 mm was sufficient to hold the bony elements. Check image-intensifier was acceptable. Insertion of Satellite PEEK nucleus replacement sphere No 13 was acceptable and  and it was pushed centrally.

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

Recurrence in this case could be more than 30%, since the disc space height is still not shallow and the defect is wide. Insertion of PEEK Satellite nucleus replacement sphere could decrease this incidence to below 2%.

Lumbar canal stenosis was adding the deleterious effect of compression and causing the severe neurological deficits. It was corrected accordingly.