The patient came to the clinic 18-June-2014 complaining of LBP with right sciatica for 3 months with exacerbation the last three days with numbness of the right S1 territory with positive cough sign. MRI lumbar spine done 16-June-2014 showing huge extruded disc L5-S1 with right downward migration.

On examination; The patient cannot set in chair, limping with exaggerated scoliotic stance. SLRS 5 degrees with pain in the right  and 40 degrees with pain shooting to the right leg. The right AJ is decreased in the right side. there is weak dorsiflexion right foot -3/5 and planterflexion same foot 2/5.

Using the C-arm, the L5-S1 level identified. Using MICRODISCXS and VITOM, foraminotomy of right S1 root was done. Before reaching the dura, there was a CSF leak coming from the upper corner of the field, for what flavotomy was extended up and the dural defect was identified. It was in midline with very thin dura and it was adherent to the ligamentum flavum. The dural defect was closed by nylon 6 zero. Check by Valsalva maneuver ruled out CSF Leak. The downward migrating disc was removed lateral to the axilla in several pieces. Right sided intradiscal cleaning L5-S1 disc space. Routine closure of the wound.

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

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

The center of the sleeves must be identical with the plane of the disc space, so as to perform intradiscal cleaning.