The patient for several years have LBP with bilateral sciatica with progression over time. The last 6 months unable to walk more than 50 meters due to pain and intermittent claudication.

MRI lumbar spine performed recently showing spondylolisthesis L4-5. with overmobility, isthmolysis and segmental stenosis.

On examination: The patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 50 degrees with pain in both sides. There is weak dorsi and planterflexion both feet -4/5 with hypalgesia both L5 and S1 territories.

Skeletonization of L2,3,4,5 and upper sacrum. The flail L4 lamina was removed with bilateral L5 roots foraminotomies. Using Luque rectangle adapted to accept the natural curve of the area with sublaminar wires, slight reduction and fixation was included between S1, L5, L3, and L2.

The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. Routine closure of the wound. The harvested bone was applied lateral to the rods.

Smooth postoperative recovery. The power of both feet improved. She was sent to the ward.

The patient came to the clinic 22-February-2002 with clean wound, SLRS 75 degrees  with no senso-motor deficit.

The Luque system was started to be used for 15 years and it has merits and disadvantages. The metal is ferromagnetic and MRI cannot be done due to artifacts. It is easy to use and cause minimal harm to the patient, but the metallic sublaminar loops are susceptible to breakage. Reduction of the spondylolisthesis by this technique is not possible. Fusion for sure is secured. For that reason foraminotomy of both L5 roots is mandatory.

In retrospective analysis, t.e., 20 years from now a huge amount of transpedicular screws of thousands companies have a lot of defects and a lot of complications. (Comment written 26-March-2021).