The patient came to the clinic 20-January-2004 telling that he was operated 7 months ago for PLD L5-S1 for left sciatica without improvement. MRI done 10-January-2004 showing huge recurrence of L5-S1. He was unable to sleep horizontal due to pain. He was operated for recurrence 21-January-2004. The patient then came 01-September-2004 complaining of severe LBP with left sciatica. MRI lumbar spine done 09-July-2004 showing small recurrence and advised for conservative treatment. He came 01-September-2004 urging for surgery.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 45 degrees in the right  and 15 degrees in the left with pain. There is weak dorsi and planterflexion left foot 3/5 with hypalgesia left L5 and S1 territories.

Foraminotomy with neurolysis left S1 roots with removal of the extrusion lateral to the axilla from the left side. After that, the root became lax and left sided intradiscal cleaning L5-S1 disc space was done. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A fat in pedicle was transferred from the subcutaneous layer and covered the exposed parts of the dura and roots to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the left foot became normal. He was sent to the ward.

The patient came to the clinic 13-Septmber-2004 with clean wound and SLRS 15 degrees left sides with pain and normal power, but hypalgesia left S1 root territory.

The patient came 19-October-2004 with new MRI performed the same day showing no recurrence.

The estimated postoperative second re-recurrence is still ranking around 7%, because the disc space is still relatively not shallow.