The patient came to the clinic 15-January-2014 complaining of LBP for 20 years with left sciatica for 7 months down to the III toe left foot. CT-scan done 18-April-2013 showing spondylolisthesis L5-S1. Dynamic studies confirmed the same data. MRI lumbar spine done 01-May-2013 showing spondylolisthesis L5-S1.

On examination; the patient is limping, with exaggerated scoliotic stance. SLRS was 80 degrees left side with pain. There is weak dorsiflexion left foot 4/5. It was agreed with the patient that in case of conservative treatment failure then to consider surgery. The patient then came 08-February-2014 telling that conservative measures failed to improve her.

MRI of the lumbar spine done 08-February-2014 confirming the presence of spondylolisthesis L5-S1.

Using C-arm, the L5-S1 level identified. Skeletonization of L4, L5 and upper sacrum. The L5 lamina is completely flail. All the flail lamina was removed and foraminotomy both L5 and S1 roots was achieved. Discectomy of L5-S1 from the right side with trail to reduce the spondylolisthesis. TLIF Novel TL cage 9x10x28 mm inserted to the L5-S1 disc space. Using Isobar TTL module in system, 2 reduction monoaxial screws 6.2x45 were inserted to L5 body and 2 monoaxial screws 6.2x45 mm to upper sacrum. All stages of surgery were done under the control of C-arm. Transpedicular reduction fixation was performed at L5-S1 level with slight compression from the right side. The harvested bone was melt and used lateral to the bended rods 60 mm length with the cross connector between them. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot became normal.

The patient  has progressive spondylolisthesis with flail lamina. Surgical decompression and reduction with fixation is the best treatment choice.