The patient was operated by me 27-July-2004 for lumbar canal stenosis L4-5 and L5-S1. The patient then came 22-August-2007 complaining of LBP for 2 months without sciatica. MRI lumbar spine done 19-August-2007 showing spondylolisthesis L4-5. Sensory-motor functions were normal. The patient was advised to undergo conservative treatment. Th patient then came 11-December-2011 telling that she cannot walk the last three months due to LBP and right sciatica with numbness right foot after trauma to the right ankle. MRI lumbar spine done 13-November-2011 showing spondylolisthesis L4-5 with segmental stenosis. On examination at that time SLRS was 80 degrees both sides with weak dorsi and planterflexion right foot    -4/5 with hypalgesia below both knees. Babinski was positive both sides. The patient was sent for more investigations. MRI cervical spine showed small PCDs C4-5 and C7-D1 and dorsal MRI showed PDD D5-6, 7-8, 9-10 more to the right. Dynamic studies showed II degree spondylolisthesis L4-5 with isthmolysis. The patient was advised for decompression and transpedicular fixation of L4-5 and given admission, but she disappeared. The patient then came 03-April-2013 telling that she was operated 1 week ago without benefit. MRI lumbar spine done before the second surgery 31-March-2013 showing spondylolisthesis L4-5 with segmental stenosis L2-3, L3-4 and L4-5.

The patient then came 24-August-2014 still in agonizing pain with right sciatica with micturition problems. MRI lumbar done 24-December-2013 showing surgical approach to the S1 and S2 level. The above mentioned spondylolisthesis of L4-5 and the above stenoses still the same.

On examination; the patient is limping with help of other person with exaggerated scoliotic stance. SLRS was 70 degrees right side with pain. Babinski positive both sides. Dorsiflexion right foot -3/5, 4/5 left foot. Planterflexion right foot 3/5. The patient was sent for new investigations and done confirming the previous data.

Skeletonization of L2,3,4 and scarolysis of the lower segments. Decompressive laminectomy of L2.3.4 and foraminotomy right L5 root. Discectomy of L4-5 with insertion of TLIF cage 9x25x4⁰. Using XIA 3 2 polyaxial screws inserted to L4 and 2 monoaxial screws to L5 with 6.5x45 mm dimensions. 7 cm rods bended to accept the natural curve of the spine and MAC cross connector 38 mm were used to fuse L4-5 level with slight compression. The harvested bone was melted and applied near the TLIF inside the disc cavity and lateral to the rods. Routine closure of the wound.

Smooth postoperative recovery. The power of the right foot became better, but drop left foot took place

The patient was operated at Jordan hospital and nothing was done during surgery except approaching the S1 and S2 level. What exactly happened, I cannot understand, because sometimes the family giving disinformation.

In retrospective analysis the patient had elements of spondylolisthesis before the first surgery. This could be taken into consideration to prevent further escalation of such grade II spondylolisthesis.

The escalation of lumbar canal stenosis was not predicted in the first surgery and it was corrected with fixation of L4-5 at this stage.

Foraminotomy of the left L5 root was not performed, even the scar was not violated at the left side. The screws are in proper place. Time will tell how the drop foot will recover with time.