The patient came to the clinic 08-April-2007 complaining of severe LBP with agonizing right sciatica for one month.

MRI lumbar spine done 05-April-2007 showing huge extruded disc L4-5 with right downward migration.

The patient came to the clinic 2 months ago complaining of LBP for 4 months with with left sciatica and weak dorsiflexion left foot and hypalgesia of the left L4 territory.  MRI lumbar spine done at that time showing extruded disc L3-4 with left downward migration and bulge L4-5 with segmental stenosis at these levels.

The patient was given the opportunity to try conservative treatment, but he came 08-April-2007 confirming that his condition is deteriorating.

On examination: The patient had scoliotic stance. He had SLRS 40 degrees both sides with shooting sciatica left side. He had severe weak dorsi and planterflexion both feet and hypalgesia both forelegs below the knee.

Decompressive laminectomy L4 and partial of L3 and L5 with foraminotomy of both L4 and L5 roots left side.  Inspection of the L3-4 disc showed extrusion, mandating removal of the extrusion from the left side with meticulous cleaning of disc space from the left side, after what the left L4 root became relaxed. The epidural fat was preserved during surgery to minimize postoperative scar formation.

Smooth postoperative recovery and normalization of the power of both feet.

The patient in the first visit was in clinical status, that surgery could be avoided, for what surgical treatment was not decided at that time.

The deteriorating clinical picture made it clear that surgery is indicated.

The patient is a tall person and the spinous processii were abnormally long, requiring long incision.

Preservation of the epidural fat and using it to cover the most mobile neural parts is the best solution to prevent scar formation and ease his pain in the long run.