The patient from West Bank came to the clinic 01-February-2005 complaining of LBP with bilateral sciatica for 12 years after performed discectomy L3-4 elsewhere. He suffered deterioration last year. Myelography performed 26-October-2004 showed obstruction of the contrast at L3-4 level with extruded disc L2-3. Walking with crutches for 7 months.

On examination, SLRS was 45 degrees with pain both sides. Weak dorsi and planterflexion both feet 3/5. There is hypalgesia below the left knee  with weak right quadriceps muscle 4/5.

The patient was sent for investigation and MRI lumbar spine showing severe LCS L3-4, L4-5,

Decompressive laminectomy L3,4 with upper part of L5 and lower part of L2 with foraminotomy both L4,L5 roots. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound.

Smooth postoperative recovery. He was sent to the ward.

The patient came 10 days after surgery with SLRS 70 degrees without pain and still having hypalgesia below the left knee.

The patient then came 01-January-2011 complaining of LBP with bilateral sciatica, using crutches, walking bended anterior with weak four limbs. He was sent for investigations and MRI cervical spine done 03-January-2011 showing old extruded disc C4-5 and C5-6 with with extruded disc L5-S1 with severe stenosis at that level. He was advised for surgical treatment, but he disapeared.

The nearest fat to the epidural fat, the best for transferring. Using the epidural fat shifted by compression is the best material material is used to cover the root at the axilla to minimize the scar formation.

There is still an estimated postoperative recurrence around 7% since the sic space is not completely collapsed.