The patient was operated by me 17-Novemebr-2007 for LCS L2-3, L3-4 and L4-5. Then she came to the clinic 18-March-2014 complaining of LBP for 2 months with right sciatica. She is receiving L-thyroxin 50 microgram daily for the last 7 months and under treatment for gout.

On examination; the patient is limping with exaggerated scoliotic stance. SLRS was 40 degrees right side with pain and 50 degrees in the left. There is weak dorsiflexion both feet -4/5. MRI of the lumbar spine repeated the same day showing spondylolisthesis L3-4 and L4-5 with old extruded disc L2-3.

Using the C-arm, the L4-5 level identified. Exposure of the old wound and the lateral masses of L2-3, L3-4 and L4-5 were exposed and the transverse processii also. Drilling of the medial parts of the right L3-4 and L4-5 lateral masses. Inspection of the L4-5 disc space. It was very shallow, that insertion of TLIF cage was meaningless. Using Vitatech system, 4 monoaxial 6.5x45 mm screws were inserted to the L3 and L4 levels. 2 polyaxial 6.5x45 mm screws were inserted to the L5 level. 2 rods were bended to accept the normal curve of the area. Slight distraction of L4-5 level. Cross connector was applied. 5 cc bone graft granules were added lateral to the rods. All stages of surgery were done with C-arm control.

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

The patient has unstable back at 2 levels which needs fixation. All the compressive elements were eliminated from the right side.