The patient was operated by me 26-July-2013 for huge recurrent extruded disc L5-S1 with right foraminal occlusion. After surgery he progressed agonizing left sciatica, for what control MRI lumbar spine done after surgery, ruling out any disc material compressing the left S1 root. It was deciding taking the data in his first and last second operation done yesterday, that his spondylolisthesis of L5-S1 is the cause of his agonizing left sciatica.

The wound opened and extended up with skeletonization of L4 lamina. Complete laminectomy of the flail L5 lamina was done with removal of the flail lateral masses of L5-S1 facets. There was complete bilateral pediculolysis both sides. Foraminotomy both L5 roots and the left S1 root. Complete flavotomy L4-5 was achieved. TLIF cage Novel TL 8x10x30 mm inserted to L5-S1 disc space with bone graft to both sides of the cage (BoneSave). 2 transpedicular monoaxial Spine Alphatec  6.2x45 mm inserted to L4 body. 1 monoaxial screw 6.2x45 mm inserted to the left side of L5 and polyaxial 6.2x45 mm to the right side of L5 body. 2 polyaxial screws 6.2x40 mm inserted to the S1 body. Using bended rods 5.5x60 mm with cross connector, fusion of L4, L5 and S1 was done. All the involved roots were checked and all stages of surgery were performed using C-arm Further bone graft was added lateral to the rods.

Routine closure of the wound. Smooth postoperative recovery. Regression of the sciatica.

The patient had spondylolisthesis L5-S1 of minor degree which was neglected at the first and second surgery. The extrusion of the disc material was huge at the first and second surgery, for what the minor degree of spondylolisthesis was ignored.

Escalation of the left sciatica which was not explained by extruded disc raised the clinical importance of the instability, which was corrected subsequently.

Some patients undergo local illegal procedures such as hitting the back with wood baton, which cause fracture of the laminae. This frequent finding, made underestimation of the role of spondylolisthesis and overmobility of the spine in the clinical setup.

In the future, any disc surgery with flail bones and abnormal bony movements must be corrected by fusion and stabilization without considering its cause.