The patient came to the clinic 07-December-2013 complaining of LBP for 3 weeks with inability to walk and agonizing right sciatica for one day. Exacerbation of the LBP with right sciatica with numbness of all the toes right foot.

On examination: the patient is in wheelchair, in agonizing pain with exaggerated scoliotic stance. SLRS was 80 degrees both sides. There is weak dorsiflexion right foot 3/5 and planterflexion right foot -4/5. Dorsiflexion left foot 4/5. The right AJ is absent.

The patient was sent for neuroradiologic evaluation and MRI lumbar spine done 07-December-2013 showing extruded disc L4-5 with right upward migration.

Using C-arm, the L4-5 level was identified. Using the Cloward retractors to imitate the tubular retractors was acceptable due to cooptation with the depth of the wound. Foraminotomy right L5 root was done and the extruded disc was removed lateral to the axilla. The disc space was cleaned from the right side. Leica HM500 was used and it was acceptable for working and viewing, but very bad for video recording. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot became normal and the agonizing right sciatica disappeared.

The estimated postoperative recurrence of L5-S1 is still around 7%, because the disc space is still not completely shallow.