The patient came to the clinic 23-November-2013 complaining of LBP for 6 years with exacerbation last 2 years with bilateral sciatica more to the right with numbness both feet more the left. She cannot walk more than 150 meters. She is a known hypertensive, performed thyroidectomy and mastectomy for Paget disease 2008.

On examination is limping, in agonizing pain with exaggerated scoliotic stance. SLRS was 65 degrees both sides with pain. There is weak dorsiflexion both feet -4/5 and planterflexion left foot 4/5. There is hypalgesia both L5 and  S1 roots territories more the left.

MRI lumbar spine and dynamic studies done 24-November-2013 showing extruded disc L5-S1 and bulge L4-5 with spondylolisthesis L5-S1 I-II degree.

Laminectomy of lower 2/3 of L5 with foraminotomy both S1 roots. The lateral masses of L5-S1 are hypertrophied with callus formation and with flail pieces. Discectomy of L5-S1 from the right with insertion of Kisco Dualys TLIF  30x10x4⁰ from the right. Using C-arm, monoaxial screws 6x45 mm inserted to L5 body pedicles. 2 polyaxial screws 6x40 inserted to the S1 body. 2 bended rods 6 mm 50 mm lengths inserted and cross connector medium size 41-56 mm fixed to the rods with slight compression. Bone graft TCP+HA 5 cc was used to fill spaces lateral to the rods and intradiscally lateral to the TLIF cage. All stages of surgery were done with C-arm control. Routine closure of the wound.

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

The patient has spondylolisthesis, that make her routine life a miserable task. Surgical fixation is the only solution.