The patient came to the clinic 01-March-2007 complaining of LBP for 15 years. Exacerbation of right sciatica the last 2 months.

MRI lumbar spine done 12-February-2007 showing small extrusion L5-S1 right side. MRI done 11-December-2005 showed at that time a huge extrusion L5-S1.

The patient was given the opportunity to try conservative treatment, and she came 17-March-2007 confirming that here condition is improving.

On examination: The patient had scoliotic stance. She had SLRS 70 degrees in the right with shooting sciatica right side. She had severe weak dorsi and planterflexion right foot and hypalgesia right S1 root territory.

The patient then came asking for urgent surgery, because her condition is deteriorating.

Right S1 foraminotomy was done with partial right sided flavotomy and the swollen root was inspected and the extruded disc L5-S1 was removed lateral to the axilla. All the fresh and old fragments of the extrusion were removed. Meticulous cleaning of the disc space was performed. It was clear, that the extrusion was old and part of it was adherent to the root, for what it was dissected of the root. The congestion decreased and the foramen was checked for patency. There was no sufficient epidural fat to transfer, then the most near fat was transferred to cover the roots to minimize postoperative scar formation.

Smooth postoperative recovery and normalization of the power of right foot.

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 had a protracted course with long history, that the root was adherent to the extrusion.

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 pain in the long run, but when it is not available, then transferring the most near fat is the next alternative.