The patient came to the clinic 20-February-2008 complaining of LBP for 15 years with right sciatica for three years, then left sciatica for eight months with numbness big toe left foot.

MRI lumbar spine done 04-September-2007 showed extruded disc D10-11 right side with bulging L3-4 and L4-5. There was weak dorsiflexion both feet 4/5.

The patient was advised to try conservative measures and given anti-osteoporosis treatment..

The patient came 05-July-2008 claiming that her condition is deteriorating after treating her with local charlatans by traction and applying force by wooden instrument.

On examination: the patient in agonizing pain with scoliotic stance  with SLRS 45 degrees left side due to weakness. She had weak dorsiflexion right foot 4/5 and weak dorsiflexion left foot 3/5 and planterflexion left foot 4/5. There is hypalgesia left L5 and S1 territories with weak right quadriceps muscle 4/5.

MRI of the brain done 17-June-2008 showed small lacunar infarction right thalamus.

 MRI lumbar and dorsal spine  were performed 14-July-2008 showing further increase of the extrusion of D10-11 right side and L3-4 and L4-5.

Using image-intensifier the D10-11 was identified.

Using Midas Rex instrumentation, a modified right cost-transverse approach was applied. Drilling was done, so that the right isthmus was kept so as not to loose stability. The disc space was reached before violating the running ligamentum flavum. The disc space was cleaned from the right and the extruded disc was removed from this point.

The ligamentum flavum was removed to expose the dura. The bony part of the extrusion was removed using the telescopic attachment of Midas Rex. It was possible to drill all the bony extrusion.  By doing this, it was possible to avoid the intended transthoracic approach which was prepared in case.

Routine closure of the wound with smooth postoperative recovery.

The patient came with extruded disc D10-11 right side. She was not complaining of, for what she was kept in conservative measures.

When the clinical course took progressive character and the extrusion increase and the clinical picture became evident, that this extrusion is causing problems, it was attacked.

The use of telescoping feature of Midas Rex, made it possible to achieve drilling anterior to the dura, without performing transthoracic approach.