The patient is an Iraqi citizen came to the clinic 17-July-2011 complaining of LBP for 14 years with exacerbation of the left sciatica the last year with inability to walk more than 100 meters.

MRI lumbar spine done 16-July-2011 showing lumbar canal stenosis L2-3 and L3-4 with Lumbar X-rays showing severe scoliosis at L2 level.

On examination: the patient a known diabetic in insulin for 11 years, was limping with scoliotic stance. SLRS was 85 degrees in the left with pain. She had OA left knee with with effusion. She was also complaining of neck pain with weak both upper limbs and bilateral severe carpal tunnel syndrome.

The patient was sent for further investigations, including the dynamic studies of the lumbar spine, which confirmed the presence of unstable spondylolisthesis L3-4 and to minimal degree the L2-3 and left L4-5 lateral recess syndrome.

Skeletonization of L2-3-4-5 was done down to the lateral processi. 2 Depuy Expedium ployaxial screws 7x40 mm were inserted to the L2 pedicles. 6 monoaxial screws 6x40 mm were inserted to L3,4 and L5 pedicles. Complete laminectomy L3 and partial of L2 and L4 was performed. Left L5 root foraminotomy was done to check the root during intended traction. Discectomy L3-4 was performed from the left and the disc space was filled with her bone harvested during laminectomy. TILF 8x28 mm was inserted to the L3-4 disc space. 2 rods bended were inserted first from the left side with slight compression at L3-4 level and distraction at other levels. During the insertion of the other rod from the right side, it was noted that during forced cooptation of the lower screw, this later was shifted upward, for what, it was needed to remove this monoaxial screw and insert another polyaxial 7x40 mm, after what it was possible to make fusion. A crosslink was inserted at the level of L3-4. The bone graft was added to the construct.

Routine closure of the wound.  Smooth postoperative recovery.

The patient has multiple spine problems, which need attention and subsequent correction.

The patient had severe scoliotic curves that needs compression at parts and distraction at other points.