The patient came to the clinic 21-August-2008 complaining of bilateral sciatica for one year more the left side. He could walk less than 500 meters with intermittent claudication.

LSS X-ray performed 12-August-2008 showing spondylolisthesis L4-5.

On examination: the patient is limping with exaggerated scoliotic stance and she had weak dorsiflexion and planterflexion both feet 4/5 with SLRS was 80 degrees in both sides. He had also severe OA. both knees.

The patient was sent for MRI lumbar spine and dynamic studies, which were done 26-August-2008 confirming the presence of severe lumbar canal stenosis L4-5 with instability of the spondylolisthesis at that level.

Decompressive laminectomy of L4 and partial of the upper of L5 was performed. The hypertrophied ligamentum flavum was removed and foraminotomy of both L5 roots was achieved. Inspection of the annulus fibrosis of the L4-5 disc confirmed no extrusion and it was left untouched.

Using USS2 system of transpedicular screws, fixation of L4 with L5 was achieved. The length of the screws were 45 mm. All the time the procedure was performed under image-intensifier  control. Tightening of the rods was performed after slight distraction for 5 mm. The harvested bone was milled by Midas-Rex mil and fulfilled the space lateral to the rods.

Routine closure of the wound. The power of both feet normalized immediately after surgery.

The patient has severe lumbar canal stenosis. Decompression alone mostly will improve the power of both feet, but fixation will decrease the pain in the long run.