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.

On examination: The patient could not stand for scoliotic assessment and Romberg test. She had SLRS right 40 degrees and 5 degrees in the left. She had drop left foot with weak planterflexion of the same foot with hypalgesia left L5 and S1 root territories.

During skeletonization, the L5 lamina is flail. Inspection of the isthmi both sides revealed recent transverse fracture both of them. Revision of the MRI preformed 5 days ago did not show the presence of such fracture. Foraminotomy of right L5 root and the huge extruded disc was removed in several pieces lateral to the axilla. Meticulous cleaning of the disc space was performed from the right side and drilling of the disc space to achieve a 4 mm diameter window to the disc space. A big piece of bone harvested from the L4 spinous process was harvested and remolded to adapt it from intradiscal graft. Using the spreader the bone was pushed with impactor to the cavity to have later fusion of the area. After insertion of the graft the spreader released and check for stability of the graft, showed that back slippage is impossible. The epidural fat which was shifted upward due to severe compression, was transferred down to the level of relaxed roots.

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

The patient is denying recent trauma to the spine but, she admitted that she went for traditional local treatment modalities, such are doing burn in certain points. But the brother admitted that she felt down from 4 meters 1 month ago.

This case is not unusual, since the local population believe in certain traditional therapies, such as burning and using woody instruments, which could cause such fracture. These low intelligent people usually try to hide this information and such findings are usually discovered during surgery.

Due to poverty, the surgeon must act to resolve the fracture problem with minimal cost. The bone was harvested from the spinous process and impacted to the disc space with tension to aid future fusion.

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 here pain in the long run.