The patient came to the clinic 06-October-2013 complaining of LBP with left sciatica for 3 years with exacerbation the last month with inability to walk more than 100 meters. She was limping with SLRS left side 30 degrees with pain and hypalgesia left anterior thigh and weak dorsiflexion left foot -4/5. She was also complaining of neck pain. MRI cervical spine done showing small extruded disc C6-7 and the lumbar MRI showed spondylolisthesis L4-5. Dynamic studies confirmed the instability at L4-5. The patient then came 10-May-2015 complaining of agonizing right sciatica for 2 months.

On examination; the patient is limping with exaggerated scoliotic stance. Neck and upper limbs were neurologically free. SLRS was 80 degrees both sides. There is weak dorsiflexion both feet -3/5.

The patient was sent for investigations and MRI lumbar spine performed 10-May-2015 showing spondylolisthesis L4-5 with right extraforaminal extrusion L4-5. There are bulging disci all over.

Using the C-arm, the L4-5 level was identified. Using Legacy CDH MAS screws 6.5x45 mm 4 screws inserted to L4 and L5 levels. The extruded far lateral disc of L4-5 was removed and right sided intradiscal cleaning was achieved. The patient had bleeding tendency, for what Vit K 10 units was injected. 50 mm bended rods were used and cross connector 22 were applied to obtain fusion and distraction about 5 mm both sides. All stages of surgery were done with C-arm control. The harvested bone was milt and applied to the rods. Routine closure.

Smooth postoperative recovery.

The patient was tolerating the spondylolisthesis, but when the extrusion took place, she urged for surgery. Both problems were corrected accordingly.