The patient came to the clinic 16-November-2000 telling that she was operated 10-May-1997 for PLD L4-5 elsewhere and improved. The last month got exacerbation of LBP with left sciatica as previously, MRI lumbar spine done 3 days ago showed bulge disci D12-L1, L3-4, L4-5 and L5-S1. There was weak dorsiflexion left foot and she was treated conservatively. She came several times and conservative treatment was suggested. The came to the clinic 23-August-2004 complaining of LBP for 13 days with MRI done the same day showed huge extruded disc L4-5 with left downward migration.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 50 degrees in the right  and 20 degrees in the left with pain. There is drop left foot with weak dorsiflexion right foot 3/5 with hypalgesia left L5 and S1 territories.

Foraminotomy with neurolysis left L5 roots with removal of the huge extrusion lateral to the axilla from the left side. After that, the root became lax and left sided intradiscal cleaning L4-5 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 right foot became normal, but the left drop foot still the same. She was sent to the ward.

The patient came to the clinic 11-Septmber-2004 with clean wound and SLRS 80 degrees both sides without pain and still having drop left foot.

The patient came several times then came 07-June-2008 complaining of LBP with left sciatica for 3 weeks and MRI done 04-June-2008 showing left far lateral extrusion L3-4. She was advised for surgery.

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