The patient came to the clinic 01-December-2008 complaining of right sciatica for three weeks with exacerbation the last three days. The patient was operated by me 20-July-2008 for huge PLD L5-S1 right side. He was in good condition for 3 months.

MRI lumbar spine performed 30-November-2008 showed a small recurrence at L5-S1 right side compressing the right S1 root.

On examination: the patient  had mild scoliotic stance. SLRS was 20 degrees right side and 50 degrees in the left. He had no neurological deficit.

Considering that the small extrusion was soft inconsistency, it was decided to keep in conservative treatment, but the patient continued to complain and repeat MRI done 24-December-2008 showed the same recurrence and the patient urged for surgery.

The upper right bony edge of the previous approach was refreshed and the massive scar was removed so as to reach the extruded piece. Using image-intensifier, the L5-S1 disc was identified and the extruded disc was pushed to the disc space and from there removed after that. Meticulous cleaning of the disc pace was performed from the right side. Scarolysis and exposure of the right S1 root was performed to check for remnants. A thin layer of scar was left to avoid tear of the dura. Routine closure of the wound.

Smooth postoperative recovery and the right sciatica disappeared after surgery.

The patient had small recurrence at L5-S1 which could be treated conservatively. Despite the fact, that the piece was a small but, it severely compressed the nerve, for what the patient urged for surgery.

The actual recurrence rate after disc surgery is around 30%, but only 7% require surgery. Usually most of them having huge extrusion with a small group of patients having small to medium size fragments compressing the nerve as in this case.

The expected recurrence in this case now is minimal, because the disc space became shallow.