The patient came to the clinic 27-July-2011 complaining of LBP and left sciatica, which did not disappeared after performing transpedicular fixation for spondylolisthesis L3-4   several months ago elsewhere. The patient is claiming that, she did not recover after surgery, instead her condition became worse.

CT-scan done 06-March-2011 construct in acceptable position, but MRI lumbar spine done 20-March-2011  showing that the previous extruded disc of L3-4 still compressing the left L4 root. MRI repeated 03-April showing the same data.

On examination: the patient is limping with exaggerated scoliotic stance. There is weak dorsiflexion left foot -3/5. SLRS was 70 degrees in the left side with pain.

Exposure all the screws which are seem to be polyaxial Ziva and they were in acceptable position and not loose. Foraminotomy of left L4 root with scarolysis with drilling of all bony compression. Discectomy of L3-4 from the left. Depuy Spine Leopard TLIF size 9 was inserted with Vitos bone graft. The cross connectors were inserted to the rods after slight bending. The knots of the screws were returned back and slight compression was applied. Check with C-arm showed acceptable reduction of the spondylolisthesis. The left L4 root is hanging free.

Routine closure of the wound.  Smooth postoperative recovery  with improvement of the power of left foot.

Transpedicular screw fixation alone in the presence of disc extrusion will not help the patient and he will continue to suffer from the main problem of root compression.

All the patients with TLIF insertion have superior results in comparison with the previous group of patients without TLIF.

Applying connector, gives the construct more stability. Without this, there is micromovement of the constructs during walking, which will trigger pain generation. Applying the connector will unite the constructs to one stable construct.