The patient came to the clinic 22-August-2004 complaining of LBP with left hip pain for 5 years and left sciatica and numbness left L5 territory for 1 month. The patient was limping with exaggerated scoliotic stance with SLRS 80 degrees both sides and weak dorsi, planterflexion both feet and quadriceps femoris both legs 4/5. MRI dorsal and lumbar spine performed 24-August-2004 showing small extruded disc D11-12 and spondylolisthesis L4-5 with bulge disc at this level. The patient was welling with conservative treatment and he came 18-November-2007 claiming that after TUR got exacerbation of numbness of the left foot with dyseasthesia. MRI lumbar spine performed 13-May-2007 showing spondylolisthesis II degree with secondary stenosis. The patient then came 21-May-2008 with the same clinical picture, but claiming that he had episodes of improvement and he could walk more than 1 Km. The patient then came 17-August-2010 claiming that he got dramatic deterioration the last 2 weeks, dragging his both legs and he could not walk more than 20 meters with bended and scoliotic stance. The power of the right foot became weaker than before and the patient was advised to undergo surgery, but he escaped. The patient is a known diabetic. The patient then came 10-December-2011 complaining of both buttock pain with inability to walk more than 50 meters. The scoliotic stance became more exaggerated with more weak both feet.

MRI of the lumbar spine done 29-December-2011 showing second degree L4-5 spondylolisthesis with segmental stenosis at L3-4 and L4-5 with old fracture of D11.

Skeletonization of L3-4-5 and partial of L2 down to the transverse processii L3, 4 and 5. Laminectomy L4 and partial of L5 and L3. Foraminotomy of L4 and L5 roots both sides. The left L3-4 lateral mass was fractured with isthmolysis. Both L3-4, and L4-5 were over mobile. There was no epidural fat at the operative level. Discectomy L4-5 and L3-4 from the left side. TILF cage 9 mm inserted to L4-5 level and No 10 to L3-4 level with Novabone and bone grafts harvested from the spinous processii. SpineWay Polyaxial reduction screws 6x40 inserted to L4 pedicles. Polyaxial reduction 7x45 screws inserted to L3 level. Polyaxial reduction screws 6x45 mm inserted to L5 level. 2 rods  bended to adapt the natural curve of the area were used with crossLink multidirection. The area lateral to the rods was aided with bone grafts.

Routine closure of the wounds. Smooth postoperative recovery with improvement of the power of both feet.

The patient have II degree spondylolisthesis with segmental stenosis L3-4, L4-5. During surgery it was found that L3-4 was more mobile than L4-5. It was necessary to resolve the problem to both levels.