The patient came to the clinic 03-November-2014 complaining of difficult walking for 2 years with LBP for 30 years. MRI lumbar spine done 19-July-20111 showing lumbar canal stenosis L4-5. The patient is a known diabetic for 5 years. Arterial hypertension for 7 years  and stinting of the coronaries 2012.

On examination, the patient is limping with exaggerated scoliotic stance with shooting left sciatica. SLRS was 90 degrees both sides with pain in the left. There is weak dorsiflexion left foot -3/5 and right 3/5. Planterflexion left foot 3/5 and right 4/5. There is weak both quadriceps muscles 4/5. 

The patient was sent for MRI dorsal and lumbar spine which were done 04-November-2014 showing small disci at the dorsal spine of no clinical significance and spondylolisthesis L4-5 with severe segmental stenosis. Dynamic studies confirmed the presence of the spondylolisthesis of L4-5.

Skeletonization of L4,5 and upper sacrum to partially expose the lateral processii of L4 and L5. Using Medtronic legacy polyaxial screws 6.5x45 mm  with bended 5.5 mm bended 2 rods 50 mm length, transpedicular fixation was done at L4-5 level. Laminectomy 3/4 of L4 and upper fourth of L5 was done with foraminotomy of both L5 roots. During surgery C-arm was used and ISIS transpedicular set was applied. The screws were not responding even to 15 mA DNS and the root were responding to 2 mA DNS. Cross connector 22 mm was used to provide more stability of the construct and his own bone was melted and applied lateral to the rods. Routine closure of the wound.

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

The patient still has a progressive disease, the earlier the surgical correction the better the outcome.