The patient came to the clinic 09-September-2003 telling that he was operated 3 years ago for PLD L3-4 for right sciatica then he started to complain of left sciatica in January-2003, then right sciatica the last 2 months. Diabetic for 1 year in treatment. Cath done 7 years ago was normal.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 40 degrees in the right  and 70 degrees in the left with pain. There is weak dorsi and planterflexion right foot 3/5, weak right quadriceps muscle -4/5 and abduction right knee 4/5..

The patient was sent for investigations and MRI done the same day showing huge recurrent disc L3-4 with right downward migration.

Foraminotomy with neurolysis right L4 root with removal of the extrusion lateral to the axilla from the right side. After that, the root became lax and right sided intradiscal cleaning L3-4 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. He was sent to the ward.

The patient came to the clinic 21-Septmber-2004 with clean wound and SLRS 60 degrees both sides with pain and normal power and sensation.

The patient came 04-December-2003 with new MRI performed the same day showing recurrence L3-4 right side and advised for surgery, but he disappeared.

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