The patient came to the clinic 16-August-2014 complaining of LBP with right sciatica for 2 years with exacerbation of the sciatica the last 2 weeks down to the big toe right foot. The patient is a known hypertensive for 10 years. MRI lumbar spine done 13-August-2014 showing spondylolisthesis L4-5 and antelisthesis L2-3 with severe stenosis L2-3, 3-4 and L4-5.

On examination; the patient is limping with exaggerated scoliotic stance. SLRS was 70 degrees with pain in the right and 90 degrees in the left with pain shooting to the right. Weak dorsiflexion both feet -3/5.

The patient was sent for MRI of the pelvis and dynamic studies of the lumbar spine and done confirming the above mentioned diagnosis.

Skeletonization of L2,3,4,5 and upper sacrum. Inspection of the spine: all segments are flail. Foraminotomy of right L5 root with discectomy L4-5 from the right with insertion of TL cage 8x25x0⁰x8 mm. XIA 3 monoaxial screws 6.5x45 were inserted to the L5 body and one to the left side of L4. Ployaxial screws 6.5x45 were inserted to L2, 3 and right side of L4. Decompressive laminectomy L3,4 and lower half of L2 and upper half of L5. 2 bended rods were used with cross connector MAC 42 mm length with allograft were used to obtain transpedicular fixation L2,3,4 and L5. Slight compression was applied at the level of L4-5 from the right and more from the left. The harvested bone was applied lateral to the rods. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet became normal.

The patient has a lot of problems which needed surgical correction.