The patient came to the clinic 31-August-2015 complaining of numbness left lower limb for 4 years with back pain and both upper limbs pain for 6 months. The patient is a known rheumatoid under treatment with Prednisolone and Quinoric 200 mg once daily. He has both elbows deformity more the left with limitation of the left elbow flexion not less than 70 degrees. He has atrophy of all muscles more the proximal.

On examination: the patient was not limping with no scoliotic stance. There is weak left biceps 4/5, grip both hands -4/5, extension both hands 3/5, and both triceps 4/5. There is weadk dorsiflexion left foot -4/5. The AJ is absent in the left side.

The patient was snet for investigations and MRI cervical spine done 31-August-2015 showing minor degree of stenosis at C3 down to C7 level without proper malacia of the spinal cord. MRI lumbar spine showing spondylolisthesis L4-5 with severe stenosis at this level. Dynamic studies confirmed this. ESR was 36 mm/h and CRP 103 mg/dL.

Skeletonization of L4, 5 and upper sacrum. Transpedicular fixation L4 and L5 was achieved using Legacy F.A. screws 6.5x45 mm with bended rods 5.5x60 mm Decompressive laminectomy lower 3/4 of L4 and upper fourth of L5. Foraminotomy both L5 roots. Cross connector applied and the harvested bone milted and applied lateral to the rods. Routine closure of the wound.

Smooth postoperative recovery. The power of left foot became normal. The patient was sent to the ward.

The patient has complete stenosis with spondylolisthesis. The injurious process of this condition will escalate with time. The sooner the surgical intervention, the better the results.