The patient a Qatari citizen came to the clinic 05-August-2004 complaining of LBP with bilateral sciatica, more the right for more than 2 years. Exacerbation last year and drop right foot for more than 4 months. MRI lumbar spine done 14-August-2004 showing huge extruded disc L2-3, extruded disc L5-S1 with left downward migration with elements of LCS L4-5. He is diabetic for 8 years under treatment and insulin dependent.

On examination, the patient in agonizing pain, limping with exaggerated scoliotic stance with drop right foot, weak dorsiflexion left foot 3/5 and planterflexion right foot. SLRS was 70 degrees with pain both sides with pain. The right KJ is absent.

Through 2 separate incisions, discectomy L2-3 with left sided cleaning. Laminectomy L5 with decompression L4-5 with foraminotomy left S1 root and discectomy L4-5 with removal of the extruded disc and foraminotomy right L5 root. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. The epidural fat was transferred to the left axilla area. A fat was harvested from the subcutaneous layer with pedicle and transferred and covered the exposed parts of the root to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The right drop foot still the same but the power of the other muscles normalized.

The patient came to the clinic 26-August-2004 with fever after the third day of surgery, clean wound and improved all muscles lower limbs except for the drop right foot with no sensory deficit. SLRS was 80 degrees with pain both sides.

There is still an estimated postoperative recurrence around 7%, because the disc space is still not completely collapsed.