The patient came to the clinic 29-December-2013 complaining of LBP with right sciatica for 5 years with exacerbation last 2 years. Right sciatica with numbness of the right right foot the last 6 months.

On examination: the patient is limping with scoliotic stance. SLRS was 40 degrees right side with pain and 65 degrees left side with less pain. There is weak dorsiflexion both feet 4/5 and planterflexion right foot 4/5.

MRI lumbar spine done 30-December-2013 showing spondylolisthesis L3-4 with segmental stenosis at L3-4 and L4-5.

Using C-arm, the L3-4 level was identified. Laminectomy of L3 and L4. Foraminotomy right L4, L5 roots. Discectomy of L3-4 from the right with insertion of Vitatech/France TLIF cage 10x30x5⁰ from the right. Bone graft was added to both sides of the cage. Monoaxial screws 6.5x45 mm were inserted to L3,4 and L5 levels. Bended rods 5.5 mm were bended to accept the normal curve of the spine. The left rod was exposed to spreading in attempt to minimize the scoliosis. Slight compression was applied at the right L3-4 level. Cross connector with holders were applied. All stages of surgery were done with C-arm control. ISIS Inomed check screws was applied by using the transpedicular set. The roots were responding to 6 mA DNS. The screws did not respond even to 15 mA DNS. There was a pinpoint tear of the dura, which was repaired by nylon 4 zero.

Smooth postoperative recovery. The power of both feet became normal.

The patient has scoliosis, spondylolisthesis and stenosis. All of them must be corrected during surgery, to obtain the maximal beneficial result.