The patient came to the clinic 06-January-2013 complaining of LBP with bilateral sciatica more the right for 8 months with the right sciatica down to the big toe right foot and down to the left knee. She cannot walk more than 20 meters. MRI lumbar spine done 30-July-2012 bad quality, not informative.

On examination 05-February-2013: The patient is limping with exaggerated scoliotic stance  with SLRS 85 degrees with pain in the right. There is weak dorsiflexion both feet -4/5.

MRI lumbar spine repeated 08-January-2013 with dynamic studies showed spondylolisthesis L3-4 with severe segmental stenosis. Gout was diagnosed and CRP was 9.5 mg/L and ESR was 28 mm/h  with decreased levels of Vit D3.

Skeletonization of L3, L4 and part of L5 laminae. 3/4 laminectomy of L3 and upper 1/4th of L4. Foraminotomy of the right L4 root. Discectomy of L3-4 from the right. Insertion of DePuy  interbody cage (TLIF) 5 degree 9x28x9 mm dimensions. Using J&J polyaxial screws 6x45 mm, transpedicular fixation was done with 2 bended rods 5.5 m with cross connector. All stages of surgery were performed with C-arm control. A slight compression was applied before tightening the nuts. The bone harvested from the laminectomy was used to fill the intradiscal space and lateral to the rods.

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

The patient cannot walk more than 40 meters. Stenosis and spondylolisthesis must be corrected surgically.