Autogenic free fat tissue (FFT) is widely used in neurosurgery. Since the 1960s, there has been discussion on the usefulness of fat graft in spinal surgery. Unfortunately, fat undergoes atrophy, fibrosis, and rebuild, and up to 55% of primary volume disappears. This review focuses on the following aspects: development of radiological assessment, evaluation of morphological changes, and the influence of fat graft on outcome. Fat graft in the spinal canal disappears after degeneration processes. High amounts of collagen in the studied tissue and proliferation of blood vessels were observed. Use of fat as a filler and dural sac sealer is well grounded; however, the prevention of scar formation is uncertain. The use of fat does not eliminate adhesion and scar formation near the dural sac. Meanwhile, as the results of the discussed studies show, routine use of fat graft in prevention of scar formation cannot be justified.