The patient a Yemeni citizen came to the clinic 05-April-2001 complaining of LBP with left sciatica for 4 years with right sciatica for  2 months. Cannot walk more than 10 meters due to pain. MRI lumbar spine performed 03-March-2004 showing severe lumbar canal stenosis L4-5.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 85 degrees in the right with pain. There is almost drop right foot and weak dorsi and planterflexion both feet 3/5 with hypalgesia right L5 and S1 territories.

The patient was sent for investigations and MRI lumbar spine performed 06-April-2004 showing severe stenosis L4-5 and extruded disc L5-S1 right side.

Laminectomy L5 with lower third of L4 and upper edge of the sacrum  and foraminotomy both L5 and S1 roots with removal of the extrusion lateral to the axilla. After that, the root became lax and right sided intradiscal cleaning L5-S1 disc space was done. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A free fat was harvested in several pieces from the subcutaneous layer and covered the exposed parts of the dura and roots to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the left foot became normal, but dorsiflexion right foot became 4/5. She was sent to the ward.

The patient came to the clinic 17-April-2004 with clean wound and SLRS 85 degrees both sides without pain and weak dorsiflexion right foot 4/5 and hypalgesia right L5 and S1 roots.

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