The patient came to the clinic 24-April-2006 complaining of left sciatica  for six months without LBP.

MRI lumbar spine done 02-April-2006 showed spondylolisthesis L5-S1 with isthmolysis. There was no scoliosis  with weak dorsiflexion left foot 4/5.

The patient was advised to try conservative measures.

The patient came 07-July-2008 claiming that his condition is deteriorating with bilateral sciatica more to the left.

On examination: the patient in agonizing pain with scoliotic stance  with SLRS 80 degrees both sides without pain. He had weak dorsiflexion right foot 4/5 and weak dorsiflexion left foot 3/5 and planterflexion left foot 4/5.

 MRI lumbar spine  which was performed 09-July-2008 showing spondylolisthesis L5-S1 and dynamic LSS X-rays confirmed the presence of bilateral isthmolysis.

Laminectomy of the flail L5 was performed and foraminotomy of both L5, S1 and S2  was achieved. Lateral to the S2 root and below the trajectory of the S1 roots the lower screws were inserted from both sides, using the multiaxial version and 35 mm length and 5 mm diameter.

Using image-intensifier, the pedicles of L4 were identified and the upper screws were inserted subsequently. All the time check imaging was performed. The rods were bended to accept the natural configuration of the spine and inserted to the construct and fixed after applying traction for 15-18 mm. A bridge was inserted to obtain more stable construct.

The harvested bone was used to obtain fusion lateral to the rods.

Routine closure of the wound and smooth postoperative recovery with normalization of the power of both feet.

The patient came two years ago and trail for conservative treatment ended with failure.

The transpedicluar fixation must be always be done with bridge to obtain more secure stability of the construct.

The traction must be applied with medium effort to avoid traction injury of the running nerves.

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