The recurrence rate in this case still ranking around 14% because the disci spaces are not completely collapsed.

The patient was operated by me 09-October-2002 complaining of LBP for 1 month with left sciatica. She was operated elsewhere twice for PLD 18 and 10 years ago. MRI lumbar spine done 16-August-2002 showing residual after discectomy L4-5 and L3-4 with stenosis at L2-3 and extrusion at L2-3 and L3-4 disci. She is a diabetic for 10 years in treatment. The patient was advised to be operated, but she escaped. Then she came 24-February-2003 and repeat MRI was requested and planned for surgery.

On examination: the patient in pain, limping with exaggerated scoliotic stance. SLRS was 90 degrees without pain both sides. There is weak dorsiflexion both feet -4/5, planterflexion left foot and hypalgesia below left L2 dermatome with diabetic neuropathy.

Decompressive laminectomy L2.3.4.5 with foraminotomy both L3,4,5 roots both side. Discectomy of L2-3 and L3-4 was achieved from the left. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound. Smooth postoperative recovery. The radicular pain decreased and the power of both feet improved. She was sent to the ward.

The patient came to the clinic 18-January-2004 with clean wound. She is complaining of ataxic gait with no sciatica. Sensation was normal except for diabetic neuropathy with weak dorsiflexion big toe left foot 4/5. She was treated conservatively.

The patient then came 15-June-2009 telling that she was operated for fracture left hip 14 months ago. She is complaining of numbness both legs with pain. She was OK before falling down and now in wheelchair. There is tremor both hands. A suspicion of fracture of the dorsal spine  for what she was sent for investigation.

The patient last time came 22-June-2009 with bone scan done 21-June-2009 showing scattered mts, for what she was sent for oncology for further investigations.