The patient is a pediatrician came to the clinic 05-June-2007 complaining of LBP for 5 years. He had similar episode 10 moths ago. Exacerbation the last month with bilateral sciatica more the left.

On examination: he was limping with scoliotic stance. SLRS was 70 degrees in the right with pain and 75 degrees in the left. He had weak dorsiflexion both feet.

MRI lumbar spine performed 30-May-2007 showed huge extrusion of the L4-5 disc with upward migration reaching the above disc level.

Bilateral flavotomy without using image-intensifier was performed to which to be the L4-5 disc space with bilateral cleaning of the disc space of which to be supposed the L4-5 disc space. The disc material was friable, but the huge extrusion was absent. Suspicion about the level came in mind and check level by image-intensifier showed that the level was L3-4. Laminectomy of L4 was done and the L4-5 disc was cleaned from both sides. The huge extrusion was adherent to the dura and it was possible to remove it by piece-meal fashion from both sides. After that the roots became relax and check of the foramina were negative for compression.

Routine closure of the wound with smooth postoperative recovery and normalization of the power of both feet.

The patient's anatomical landmarks were misleading, that the level was wrong. It is mandatory to perform image-intensifier check, even when the disc is at L4-5 or L5-S1 level to avoid such a mistake. Over than 3000 operations at these level were performed by me, without using the image-intensifier, but the patient was doctor and the recomenditis, took place with this fashion - wrong level. For that reason, it is better to use image-intensifier to avoid such mistake, without considering the amount of your personal experience.