The patient came to the clinic 13-March-2004 complaining of LBP for 5 years with exacerbation last month with with right sciatica down to the right S1 territory and positive cough sign. MRI lumbar spine performed 22-February-2004 showing huge extruded disc L4-5 with right upward migration and bulge L5-S1 right side.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 30 degrees right side with pain. There is weak dorsi and planterflexion right foot 4/5 with hypalgesia right L5 territory.

Foraminotomy right L5 root with removal of the extrusion lateral to the axilla. After that, the root became lax and right sided intradiscal cleaning L4-5 disc space was done. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A fat with pedicle was transferred from the subcutaneous layer and covered the exposed parts of the root, to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of right foot normalized.

The patient came to the clinic 01-April-2004 with clean wound and SLRS 60 degrees right side with tightness and normal power right foot and sensation. Still having numbness of the right L5 territory.

The patient then came 18-April-2004  with the same condition. He was treated conservatively.

The patient then came 23-May-2004 complaining of fainting attacks with BP 150/110 mm Hg and he was advised to treat hypertension with G.P.

The estimated postoperative recurrence is still ranking around 7%, because the disc space is still relatively not shallow.

All the times the fat was transferred without pedicle and this is the first case that the fat with pedicle was transferred to keep the fat tissue alive.