The patient came to the clinic 26-July-2017 complaining of LBP for 3 years with right sciatica for 10 days down to gastrocnemius not reaching below the ankle. The patient is a known hypertensive for 3 years under treatment.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 30 degrees with pain in the right and 70 degrees in the left. There is weak dorsiflexion right foot -4/5.

The patient was sent for investigations and MRI lumbar spine performed the same day, showing spondylolisthesis L4-5 and bulge L3-4. Dynamic studies confirmed the presence of II grade spondylolisthesis L3-4 and L4-5. lab investigations showed Hb 11.4 mg/L WBC 11.5 and ESR was 60 mm/h. The patient was given antibiotics to minimize postoperative infection and she has allergy to Dalacine. Cardio consultation reporting low risk for G.A.

Skeletonization of L3,4,5 until the lateral proccessi were under vision. Transpedicular reduction and fixation of L3,4,5 was achieved using OSImplant system with 2 polyaxial 5.5x45 mm to L5 and 4 monoaxial same sizes to L4 and L3 levels. During bony dissection, it was noticed that the right lateral mass of L4-5 suffered fracture for what, she was complaining of right sciatica. Since there was no stenosis nor proper extrusion it was decided not to violate the neural structures. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot normalized and she was sciatica free. She was sent to the ward.

The patient has spondylolisthesis at 2 levels. Fusion must include both levels.