The general concept was that the graft’s adipose tissue remodels in relation to the bony defect and acts like a greasy fluid permitting gliding of the roots and the dural sac on it. Since then, several clinical studies in favor of epidural free fat graft application for reducing peridural fibrosis was published so far. In the same year, Keller demonstrates the fate of epidural free fat graft (FFG). used a layer of free fat graft for prevention of epidural fibrosis formation for the first time. Subsequently, preliminary experience indicating that adipose tissue acts as a barrier to fibrosis was reported by Langenskiöld and Kiviluoto in two separate papers in 1976. Rocca and Mc.nab were the first who reported the scenario of post-laminectomy peridural fibrosis and called it the laminectomy membrane. Up to 20% of the patients undergoing lumbar discectomy might suffer from this complication. Lumbar discectomy is being done in increasing frequency worldwide where formation of epidural scar formation has been known as a common cause of its failure. Keywords: Cauda equina syndrome Lumbar discectomy Epidural scar Therefore, overgrowth of free fat graft should be added to all previously describe unusual complication of lumbar discectomy. To our knowledge, although overgrowth of fat has been reported in other locations, but this is the first example occurring after its application at the site of laminectomy. Piecemeal surgical removal of fat with clearance of the theca and the corresponding nerve roots result in steady but good recovery within a few weeks. The MRI obtained urgently revealed significant overgrowth of the free fat graft that had been already used for prevention of scar formation. Herein, the authors present a middle-age man who was admitted with cauda equina syndrome for one day duration developing 11 years after a redo laminectomy for recurrent disc herniation and local stenosis. However, late neurological deficit as the result of significant increase of fat graft volume has been not addressed previously in the literature. Single nerve root compression and cauda equina syndrome due to compressive effect of free fat graft with a few days to weeks after laminectomy is well known early complication of lumbar discectomy. Application of a free fat graft despite controversies has been widely used to prevent further adhesion and post-laminectomy scarring.

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