The patient came to the clinic 29-May-2013 complaining of LBP for 5 years with left sciatica for 6 months. MRI lumbar spine done 28-March-2013 showing lumbar canal stenosis L3-4 and L4-5 with spondylolisthesis L3-4 and L4-5.

On examination: The patient is limping with exaggerated scoliotic stance. There is weak dorsiflexion both feet -4/5 more weak in the left foot.

The patient was sent for MRI of the lumbar spine, which done 30-May-2013 showing severe lumbar canal stenosis L3-4 and L4-5 with extruded disc L4-5 left side. Dynamic studies confirmed spondylolisthesis L3-4 and L4-5. MRI right knee showing effusion with degenerative changes.

Decompressive laminectomy of L4 and lower half of L3and upper third of L5. Foraminotomy L4,5 both sides. All the compressive elements were removed. The dura was transparent with no epidural fat. Discectomy L4-5 from the left with insertion of TLIF cage Novel TTL 30x5x9 mm with bone graft for each side of the cage. Using Isobar TTL module In, 6 monoaxial screws 6.2x40 mm were used to fuse L3,4 and L5 bodies with slight compression of L4-5. Easys cross connector 65 mm length and 2 rods bended to adopt the natural curve were used to stabilize the construct. Bone graft was used lateral to the rods. All stage of the surgery were done under C-arm control. During right lower screw fixation, the dura was injured by the rod pusher and the 3 mm tear was repaired by nylon 4 zero and check for CSF leak was negative.

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

The patient has severe progressive lumbar canal stenosis. The earlier the surgical decompression the better the result.

The patient has minor degree of spondylolisthesis. This due to stenosis, which will escalate in case of decompression. For this reason transpedicular fixation is a must to avoid such postoperative event.