The patient came to the clinic 19-December-2013 complaining of LBP for 3 weeks with right sciatica. Exacerbation of the LBP with right sciatica with numbness of all the toes right foot.

MRI lumbar spine done 09-December-2013 showing extruded disc L5-S1 with right downward migration.

On examination is limping, in agonizing pain with exaggerated scoliotic stance. SLRS was 60 degrees right side with pain. There is weak dorsiflexion right foot 3/5 and planterflexion right foot -4/5. There is hypalgesia right L5, S1 root territories. The right AJ is absent.

Using C-arm, the L5-S1 level was identified. Using DePuy Spine Spotlight microdiscectomy tubular retractor system 24 mm, Foraminotomy right S1 root was achieved. The extruded disc was removed subaxillary in 2 big pieces and right sided cleaning of L5-S1 disc space was performed. During the procedure, several endoscopic maneuvers were applied to trade for good illumination and good video recording by the use of Leica HM500 microscope, but video recording most of the time failed during endoscopic applications.

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.

Combination of Leica microscope with Depuy spine Spotlight system, still unable to give the ideal video recording.

In the first case done 05-December-2013, the incision was midline as in this case, but sharp dissection of the bone was done before inserting the tubular system. This was done in first case to minimize the trauma to the muscles during splitting. In this case the introducers and tubular system were introduced directly without skeletonization of the bone. This caused more trauma to the muscle and misdirection of the tubular system. From these 2 scenarios, it is preferable to do we did in the first surgery.