The patient came to the Emergency of Shmaisani hospital 20-June-2002 complaining of LBP with right sciatica for 1 week. MRI lumbar spine performed 19-June-2002  showing huge extruded disc L5-S1 with right foraminal occlusion.

On examination: The patient is in agonizing pain, limping with exaggerated scoliotic stance with SLRS 20 degrees with pain in the right and weak dorsi and planterflexion right foot 3/5. There is hypalgesia right S1 root territory.

Extended foraminotomy right S1 root. The huge extruded disc was removed lateral to the right axilla and right sided cleaning L5-S1 disc space was achieved. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak.. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot normalized. He was sent to the ward.

The patient came to the clinic 29-June-2002 with clean wound and normal power right foot with SLRS 80 degrees with mild pain left side with mild scoliosis.

The patient then came 07-August-2002 with still having mild scoliosis, but neurologically free. SLRS was 85 degrees both sides without pain.

There is an estimated postoperative recurrence around 7%, because the disc space still not shallow.

Bad anesthesia, bad assistant or novice assistants, high abdominal pressure  and fatty patient, complicate the surgery. All the time bleeding having place. The anesthiologist must keep the patient in slightly low blood pressure level and the abdomen must hang free of pressure and to give the patient Tranexamic acid 1000 mg I/V will ease the surgery. Frequent irrigation with hydrogen peroxide or mixture with Tranexamic acid will make the field clear crystal. (retrospective analysis 17-April-2021).