The patient came to the clinic 03-July-2014 complaining of LBP with left sciatica for 2 years with exacerbation the last 2 days with inability to set in chair and numbness all toes left foot. MRI lumbar spine done 21-June-2012 showed extruded disc L4-5 with left foraminal occlusion.

On examination; the patient in agonizing pain, was limping with exaggerated scoliotic stance. Positive cough sign, SLRS was 30 degrees with pain in the right and 10 degrees with more pain in the left. Weak dorsi and planterflexion left foot -3/5. There is hypalgesia left L5 and S1 territories.

The patient was sent for investigations and the MRI lumbar spine performed the same day, showing the extruded disc of L4-5 with more left foraminal occlusion. Dynamic studies were normal and the ESR was 35 mm/h and CRP 9 mg/L. Zinnat 500 twice a day was started before surgery.

Using MICRODISCXS system with VITOM, left L5 foraminotomy with preservation and reflection of ligamentum flavum to the right was done. The extruded disc was removed lateral to the axilla. Left sided intradiscal cleaning of L4-5 disc space. Routine closure of the wound.

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

The estimated postoperative recurrence is still around 7% because the disc space height is still not shallow.

Preservation of the ligamentum flavum is the best way to decrease the scar formation after disc surgery. This can be achieved even with the tubular systems as in this case.