The patient came to the clinic 02-February-2007 complaining of LBP with left sciatica for 1 year with numbness of the big toe left foot. MRI lumbar spine done 25-January-2007 showing bulging L4-5 more to the left and L5-S1. The patient at that time had weak dorsiflexion left foot 4/5 with normal SLRS. The patient then came 03-February-2008 with the same complains the last 2 weeks. The weakness was the same with hypalgesia left L5 and S1 root territories. MRI lumbar spine done 04-February-2008 showing huge extrusion L4-5 left side. The patient was hesitating with surgery and he preferred conservative treatment. The patient then came 23-December-2013 with agonizing left sciatica for three days with numbness of all the toes left foot.

On examination: the patient is limping in agonizing pain with exaggerated scoliotic stance. SLRS was 40 degrees left side with pain. There is weak dorsiflexion left foot 3/5 and hypalgesia left L5 and S1 roots territories. MRI lumbar spine done the same day and extruded disc L4-5 with left foraminal occlusion was noted.

Using C-arm, the L4-5 level was identified. An incision 25 mm length done in the midline. Using Cloward retractors to expose the area, foraminotomy of the left L5 root was achieved. The extruded disc was removed lateral to the axilla. Left sided cleaning of L4-5 disc space was done. Routine closure of the wound.

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

The estimated postoperative recurrence of L5-S1 is still around 7%, because the disc space is still not completely shallow.

The Leica HM500 is very excellent in viewing, but very bad in video documentation. The windows XP 2002 is for long time obsolete, and there is mismatch between what the surgeon seeing and the monitor is showing and recording.

The Cloward retractors are not suitable all the time for key-hole surgery. It slips external and there is no holding device to prevent this.