The patient came to the clinic 05-November-2003 telling that he was operated at Palestinian authority in April-2000 and continued to complain of LBP with left sciatica with numbness left foot. He is using crutches for 8 weeks. He is hypertensive in treatment for 2 years.

On examination: the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 85 degrees left side with pain. There is weak dorsi and planterflexion both feet with hypalgesia left L5 and S1 root territories.

The patient was sent for investigation and MRI lumbar spine performed the next day showing huge recurrence of his L4-5 disc, more to the left.

Decompressive laminectomy L4-5. Neurolysis of the left L5 root was achieved. The extruded disc material of L4-5 was removed from under the axilla, which was pushing laterally the root by the huge extrusion. Left sided intradiscal cleaning L4-5 was achieved. 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.

The patient came to the clinic 30-November-2003 with clean wound and no sensory, nor motor deficit.

The patient then  came 21-November-2010 complaining of LBP without sciatica and sent for investigations and no recurrence was noted. He was treated conservatively.

There is still an estimated postoperative re-recurrence around 7% because the disc space is still not completely collapsed.