The patient came to the clinic 20-September-2014 complaining of LBP with bilateral sciatica for 2 years more to the right with numbness big toe left foot. The patient is a known hypertensive for 8 years and diabetic for 3 years. MRI lumbar spine done 01-September-2014 showing spondylolisthesis L4-5with severe stenosis L4-5. MRI cervical spine showing bulge C5-6.

On examination; the patient is not limping with exaggerated scoliotic stance. SLRS was 70 degrees with pain in the right and 85 degrees in the left with pain. Weak dorsiflexion both feet 4/5.

Skeletonization of L3,4,5 and upper sacrum. Inspection of the spine: L4-5 is flail. Foraminotomy of right L4 and L5 root with discectomy L4-5 from the right with insertion of TL cage 8x25x4⁰x8 mm. Pin point dural defect took place from the right side and it was repaired with 6 zero nylon. Trendelenburg position and Valsalva maneuver applied. No CSF leak. XIA 3 monoaxial screws 6.5x45 were inserted to the L4 body and 2 long arm 6.5x45 mm to L5. Decompressive laminectomy L4-5. 2 bended rods were used with cross connector MAC 42 mm length with allograft were used to obtain transpedicular fixation L4-5 Slight compression was applied at the level of L4-5. The harvested bone was applied lateral to the rods. Routine closure of the wound.

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

The patient has a lot of problems which needed surgical correction.