The patient was operated by me 03-April-2012 for huge extruded disc L5-S1. She was doing fine until she came to the clinic 31-March-2014 telling that she got flue last month after then started to complain of LBP and right sciatica. The last 2 days exacerbation of the sciatica with numbness of the big toe right foot.

On examination; the patient is limping with exaggerated scoliotic stance. SLRS was 5 degrees with pain right side with weak dorsiflexion right foot 3/5.

The patient was sent for MRI lumbar spine with contrast and dynamic studies of the lumbar spine and done the same day. A huge recurrence of L5-S1 was seen with right foraminal occlusion.

Using the old incision, the area was refreshed and dissection was directed to the right upper corner. There was massive fibrosis with adhesions, more than usual, indicating that the previously applied Guardix sol turned to be ineffective and giving the opposite result. Using the C-arm, the proper location of dissection was identified and removal of the extruded disc material was done lateral to the axilla. Right side intradiscal cleaning of L5-S1. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot became normal.

The patient  still has an estimated postoperative recurrence rate below 7%, because the disc space became more shallow, but not completely collapsed.

Guardix sol is not effective, in the contrary, it helps increase the severity of scar formation. The best was to decrease the fibrosis, is to preserve the anatomical structures, such as the epidural fat and the ligamentum flavum, trying to reflect it during surgery and turn it back after then.