to the clinic 20-July-2010 complaining of LBP
with bilateral sciatica for 3 years. The last 18
months got exacerbation of the right sciatica
with dysesthesia of both feet.
MRI lumbar spine
performed 17-July-2010 showing spondylolisthesis
L4-5 Meyerding grade II with secondary canal
stenosis. Dynamic studies showed considerable
shift of the L4 over the L5 upon flexion and
On examination: the
patient had exaggerated scoliotic stance, not
limping, weak dorsiflexion left foot 4/5 and
right foot 3/5 and planterflexion right foot
In the prone position, decompressive laminectomy
of L4 and partial of L5 was done. Foraminotomy
of right L5 was achieved. Using
image-intensifier transpedicular screws Zimmer
Java version were applied under the control of
neurophysiological control Inomed HighLine with
transpedicular set. It was interesting that the
direct stimulation of the left sided root were
responding to 1.8 mA with DNS 0.2 msec duration.
The left exposed L4 root was responding only to
5 mA current. The probes and the pedicle
screws did not show any response even to 15 mA
current. There was only local contraction of the
surrounding paraspinal muscles, but the EMG
records of the tibialis anterior and
gastrocnemius muscles did not show any response,
which means that the screws are away from the
root and no irritating cracks near the root.
Discectomy of L4-5 was achieved from the right.
Meticulous cleaning of the disc space was done.
TILF cage 7X5 was inserted to the center of the
Fusion with compression was applied between L4
and L5 bodies. The bone harvested from the
spinous processes and acceptable bone from the
lateral masses was used and inserted before and
after the introduction of the TILF. The
milled bone also was aided lateral to the rods
and a bridge was added to obtain maximal
security of the device.
Smooth postoperative recovery and improvement of
the power of both feet.