The patient came to the clinic 25-July complaining of LBP for more than 10 years with progressing course with right sciatica for 2 years . Inability to walk more then 100 meters.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 50 degrees in the right  and 80 degrees in the left with pain. There is weak dorsiflexion both feet 3/5 with hypalgesia right L5 and S1 territories.

The patient was sent for investigations and MRI done 27-July-2004 showing spondylolisthesis L5-S1 with extruded disc more to the right. Dynamic studies showed II degree spondylolisthesis with bilateral isthmolysis.

Foraminotomy both S1 roots with removal of the extrusion lateral to the axilla from the right side. After that, the root became lax and right sided intradiscal cleaning L5-S1 disc space was done. The flail facets were removed both sides. Using monoaxial screws to L5 and S1 fusion of L5 and S1 was achieved. The harvested bone was milled and applied lateral to the rods after reduction and distraction. The patient was put in Reverse Trendelenburg position with Valsalva maneuver and hyperventilation. No CSF leak. A fat in pedicle was transferred from the subcutaneous layer and covered the exposed parts of the dura and roots to minimize postoperative scarring. Routine closure of the wound. Smooth postoperative recovery. The power of the right foot became normal. She was sent to the ward.

The patient came to the clinic 13-August-2004 with clean wound and SLRS 80 degrees both sides without pain and neurologically free.

The case is one of the early applications of this brand of screw fixation.