The patient  came to the clinic 10-April-2012 complaining of LBP for 5 years with right sciatica for one year and bilateral sciatica for 5 months with numbness both feet, more big toe territory with intermittent claudication and inability to walk more than 100 meters. The patient is a known case of diabetes mellitus for 15 years.

MRI lumbar spine performed 10-April-2012 showing assimilation of D10 and 11 with III degree spondylolisthesis L5-S1 .

On examination, the patient is limping, dragging the right lower limb with exaggerated scoliotic stance. SLRS was 30 degrees in the right with pain and 60 degrees in the left with pain. Planterflexion both feet was 4/5 and dorsiflexion right foot -3/5 and left foot 3/5. There is hypalgesia both L5 and S1 territories.

Skeletonization of L4, 5 laminae down to the lateral processes. Laminectomy of L5 with removal of all flail parts of the lateral masses and the isthmolytic parts of the pedicles. Foraminotomy of L5 and S1 roots both sides. The L5-S1 disc space is unreachable due to severe degree of spondylolisthesis. Insertion of monoaxial Spineway transpedicular screws to the L5 bodies 7x40 mm. During insertion check X-ray and inspection of the L5 roots was considered.  Insertion of Reduction polyaxial screws 6x35 mm were inserted to S1 body with inspection of the S1 roots and under image-intensifier. The insertion was bicortical because the screws available were the shortest.  The rods were inserted and reduction distraction was applied, after what it was possible to perform discectomy L5-S1 and insert TLIF cage 8 mm height  with NeveBone. Slight compression was applied to prevent slippage of the cage. Bone chips were inserted in the disc cavity. CrossLink 55-70 mm was applied. The bone chips were applied to the rods.

Routine closure of the wound. Smooth postoperative recovery.

The patient has III degree of spondylolisthesis with bilateral isthmolysis. Surgical correction and fixation is the only solution at our present time.