The patient came to the clinic 07-January-2007 complaining of LBP for 15 years with left sciatica. LSS-X-ray done 10-October-2006 showed II-III degree of L4-5 spondylolisthesis.

On examination: The patient was limping with agonizing pain with exaggerated scoliotic stance with weak dorsi and planterflexion both feet

MRI of the lumbar spine performed showing spondylolisthesis L4-5 with isthmolysis both sides.

Decompressive laminectomy L4 and 5 with foraminotomy for L4 and L5 roots both sides was achieved and all the compressive elements were eliminated.
Using the USS II pedicular screw system with upper screws length 40 mm and diameter 6.2 mm and the lower screws with length 35 mm and diameter 6.2 mm, transpedicular screw fixation was achieved aided with crossing bridge. The dura was very thin at the lower level, that a microscopic point caused CSF leak, which was stitched using 6 zero nylon. Lateral to the rods , chips of harvested bone was inserted to achieve later bony fusion.

Routine closure of the wound and smooth postoperative recovery with improvement of the motor power both feet.

 

Spondylolisthesis I-III degree with clinical manifestations and progressive clinical course, make it mandatory to perform transpedicular screw fixation.

The goal of such surgery is to eliminate the overmobility and remove the hypertrophied elements due to pseudojoint at the isthmolysis sites and decompress all the neural structures. Otherwise, the surgeon could unintentionally harm them, which is not the case, when he bring them under direct vision.