SUMMARY: Dr. Al-hassan Dasan Andani from Accra, Ghana presents a case in which a patient from a rural setting was referred to the Greater Accra Regional Hospital for care of a rapidly progressive weakness of the lower extremities and loss of bowel and bladder control. The surgeons diagnosed Cauda Equina Syndrome. The patient had very limited resources to pay. Even the use of a drill at surgery costs money. With the assistance of Estrada Bernard, MD, the surgeons used a creative approach to a minimally invasive procedure to reach the pathology. See what they did to create a cost effective surgery after which the patient was discharged the next day. Very creative use of resources. 38 minutes (JIA)