To avoid the exiting nerve root injury, foraminoplasty is recommended to enlarge the Kambin’s triangle. After foraminoplasty, the herniated mass can be removed from the outside. Also, it is very safe to insert the cannula into the disc space for further removal of the fragments from the disc space.

This case is 28 y.o. female professional golfer. She complained severe left leg pain due to HNP at L5/s. The HNP was removed via transforaminal access with FESS following foraminotomy. After the surgery, her leg pain completely disappeared; then, she could return to the original activity 2 months after the TF-FESS.

This case is a female professional volleyball player. She attended Rio de Janeiro　Olympic Game, and after coming back to Japan she felt severe left leg pain due to HNP at L5/s. The HNP locates inside of the canal and pushes S1 nerve root. Furthermore, the HNP mass extrudes to the far lateral area, leading L5 radiculopathy (foot drop).

The traditional surgery would be removal of inside mass with Love’s procedure, and outside mass with Wiltse approach under general anesthesia; i.e. two skin incision and very invasive surgery. On the other hand, such HNP can be removed simultaneously via transforaminal access with FESS following foraminotomy. After the surgery, her leg pain completely disappeared and the foot drop was also recovered within 3 months. Successfully, she could be a National Member of Japan, and attended Tokyo Olympic Game 2021.