The patient came to the clinic 09-March-2013 complaining of LBP for 3 years with exacerbation the last 18 months  with numbness both feet more the left with inability to walk more than 100 meters.

MRI lumbar spine done 10-May-2011 showing spondylolisthesis L4-5 with complete segmental stenosis. LSS X-ray showing grade II by Myerding.

On examination: The patient is not limping with no scoliotic stance. SLRS was 90 degrees in both sides. There is weak dorsiflexion right foot 4/5 and left foot -4/5.

Investigations were repeated 10-March-2013 confirming the previous data.

Laminectomy of L4 and L5 with foraminotomy L5 roots both sides. The ligamentum flavum of L5-S1 was left untouched. The disc space of L4-5 was attacked from the left. It was very narrow and it was approached by using spreaders different diameters to perform discectomy of L4-5. Using Preservon allograft LifeNet Health the right side of the disc cavity was filled by it. Using the shortest TLIF cage  Novel TL 7x12x25 was inserted to the disc space from the left. This was intentionally done avoid complete reduction to avoid stretching of the nerves and subsequent complications from over-reduction. Using transpedicular screws IsoBar Scientex 6.2 x40 mm to the left and 6.2x45 to the right of L5 body of polyaxial version. 2 monoaxial 6.2x40 mm screws were inserted to the L4 body. Using 2 rods bended to accept the natural curve of the area, fusion of L4, L5 was done. The same bone graft was used lateral to the rods.

Routine closure of the wound. Smooth postoperative recovery. The power of both feet became normal.

The patient has high grade of spondylolisthesis. Complete reduction could trigger unnecessary postoperative complications.