The patient was operated by me 20-May-2014 for LCS L3-4 and L4-5 with right extraforaminal extrusion at L4-5. The patient then was reoperated 02-july-2014 for severe reaction of the area to the inserted during first surgery of artificial bone graft which was inserted to the L4-5 level. The patient did not improve dramatically and the right sciatica took place all the time and several MRIs were performed 28_august-2014 showing a small recurrence at L4-5 right side. An attempt was carried out to treat her conservatively, but the patient came to the clinic 07-December-2014 complaining of the same pain with MRI done 06-December-2014 showing recurrent extrusion L4-5 with right foraminal occlusion.

On examination, the patient is is in pain with SLRS 5 degrees with pain in the right without neurologic deficit.

Using C-arm the level of L4-5 was identified and foraminotomy right L5 root was performed. The extruded disc was removed lateral to the axilla and right sided intradiscal cleaning was done. Intraoperative MRI was done showing still persisting shell over and under the removed disc. Up and down further dissection with drilling of the upper and lower lip of the bone defect to ensure that no remaining shell left behind. Further foraminotomy was performed and scarolysis, trying during that to avoid dural tear. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot remained normal.

There is still an estimated postoperative recurrence below 7%.