The patient came to the clinic 23-October-2001 telling that she was operated for PLD L5-S1 17 years ago without improvement. She is complaining of numbness left hand with heaviness same hand and both lower limbs. She underwent hysterectomy with bilateral ovariectomy 4 years ago. She was limping when walking with SLRS 45 degrees with pain right side with weak dorsiflexion right foot 4/5 and hypalgesia right S1 territory. She was sent for investigation at that time and MRI of the brain showed partially empty sella and MRI cervical spine showed bulge C3-4 and C4-5, but she did not perform MRI lumbar spine. The patient then came 04-December-2004 with new MRI lumbar spine showing recurrence of L5-S1 left side with up and downward migration.

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

Left S1 foraminotomy after scarolysis with removal of the extrusion lateral to the axilla. 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 free fat was harvested from the subcutaneous layer and covered the exposed parts of the root. to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the left foot became normal. She was sent to the ward.

The patient came to the clinic 08-February-2004 with clean wound and SLRS 30 degrees left side without pain and no motor, nor sensory deficit. There is numbness left L5 root territory.

The last time she came 29-July-2004 complaining of LBP and she was given Depomedrol 80 mg intracoccygeal.

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