The patient came to the clinic 09-January-2014 complaining of left hip pain for 3 weeks with left sciatica. Today he progressed an agonizing left sciatica with limping. He was operated by me 08-February-2010 for extruded disc L4-5 with left downward migration.

On examination: the patient was limping with exaggerated scoliotic stance. SLRS was 70 degrees in the right with pain shooting to the left leg. The left KJ was absent. There is complete drop left foot with full power of planterflexion left foot. There is hypalgesia left L5 and S1 territories. MRI lumbar spine requested and done the same day, which showed huge recurrence of L4-5 with up and left far lateral extrusion.

The left upper corner of L4-5 approach was refreshed and the dura was very transparent with massive scar. There was a pin-point dural defect, through which CSF leak took place. It was repaired by 6 zero nylon. The upward migrating extrusion was removed in 2 big pieces. The left far lateral extrusion was removed in one piece.  Left sided intradiscal cleaning L4-5 was performed. Routine closure of the wound.

Smooth postoperative recovery. The power of the left foot slightly improved.

The patient has huge recurrence of L4-5. The estimated postoperative recurrence still below 7%, because the disc space height still not completely shallow.