The patient came to the clinic 07-January-2004 complaining of LBP with left sciatica for one month. She could walk more than 1 Km with SLRS 90 degrees with weak dorsiflexion all toes both feet.

MRI lumbar spine performed 22-December-2003 showed lumbar canal stenosis at L4-5 with left lateral recess syndrome. The patient is a known hypertensive and diabetic and she was treated conservatively.

The patient then came 10-May-2008 with agonizing low back pain and right sciatica for 6 days after dancing during the ceremony of her son marriage.

SLRS with pain in the right 80 degrees and 90 degrees in the left. She had weak dorsiflexion right foot 4/5.

MRI performed 12-May-2008 showed severe lumbar canal stenosis at L3-4  and L4-5 with bilateral recess syndrome with spondylolisthesis of L4-5 first degree by Meyrding. There was an extruded ganglion from the right L4-5 facet.

Decompressive laminectomy of L4 and partial of L3 and L5 was performed. Foraminotomy of both L5 roots was achieved. The ganglion was removed. It was possible to notice the linear fracture at the isthmus of right L4-5 facet.

Routine closure of the wound with smooth postoperative recovery.

Considerable improvement of the power of the right foot.

The patient has many surgical findings: stenosis, spondylolisthesis, acute fracture of the right isthmus and old ganglion from the right L4-5 facet.

The surgical treatment protocol must take into consideration all these elements and perform the optimal resolution of the problems.

The annulus fibrosis was acceptable, for what the disc structure was not violated, to prevent possible further increase of spondylolisthesis.

All the stenotic elements were eliminated to avoid further escalation of the stenosis in the scoped future.