The patient came to the clinic 05-April-2014 complaining of LBP for 11 months with left sciatica. MRI lumbar spine done 18-December-2013 showing extruded disc L4-5 more to the left.

On examination; the patient is limping. SLRS was 50 degrees in the right and 30 degrees with pain in the left with weak dorsiflexion both feet -4/5. The patient was sent for another MRI and done the same day, showing the extruded disc L4-5 with left downward migration. There is huge lipoma in the right midback of no clinical significance.

Using C-arm, the L4-5 level was identified. A 22 mm incision was used and dissection and drilling of area to accept the MICRODISCXS spreading sleeve 18x45mm. Foraminotomy left L5 root. The extruded disc was removed lateral to the axilla and left sided intradiscal cleaning of L4-5 disc space. Subaxillary inspection revealed bony hard elevation, which was nibbled. The root is hanging free, though it is slightly edematous.

Smooth postoperative recovery. The power of the left foot became normal.

The patient  still have an estimated postoperative recurrence around 7%, because the disc space is not completely shallow.

The Medicon MICRODISCXS is an excellent setup. It is a versatile retractor system, for what it is preferable to have more several options. The available diameters are 15 and 18 mm. It will be more excellent to have  20, 22 and 24 mm diameters to cover all the expected conditions during various surgeries.

During this surgery the video recording was bad in quality, for what internal illumination and using other technologies such as the VITOM of Carl Storz will be an excellent complimentary element to achieve good video recording.