The patient came to the clinic 06-January-2008 complaining of neck and left upper limb pain for 45 days. MRI of the cervical spine performed 01-January-2008 showing extruded disc C6-7 left side and bulge C5-6.

The patient walking with crutches after falling down 2 months ago. The patient was operated 13 years ago for PLD L5-S1 after what he complained of left sciatica and almost drop left foot with anaesthesia of the left L5 territory. For the cervical pathology, the patient was advised to try conservative treatment.

The patient came 09-January-2008 with MRI lumbar spine performed 14-September-2007 showing recurrence of PLD.

The patient was sent for another MRI, which was performed 11-January-2008 showing assimilation of L5 with S1 with recurrent disc L4-5 with left downward migration and possible intradural involvement.

Using image-intensifier, the level was identified and left L4-5 hemiflavotomy with left L5 foraminotomy was performed. The extruded disc was attacked lateral to the axilla. Piecemeal resection of the extrusion was done using micropituitaries from the percutaneous kit. After removing the intradurally extruded disc fragments CSF came out. The dural defect was closed with 2 nylon 6 zero stitches and covered with thread of muscle.

The disc space was very shallow and cleaning from the left side was performed.

Routine closure of the wound.

Smooth postoperative recovery and the power of the left foot dorsiflexion improved.

The patient has shallow disc space. This indicate low expectation for recurrence.

Studying the MRI carefully, the intradural compartment was discussed with the patient preoperatively and it was corrected accordingly.