The patient came to the clinic 20-September-2015 complaining of neck and LBP for 8 months with inability to walk more than 100 meters. He had flue with cough for 2 days.

On examination: the patient was limping with exaggerated scoliotic stance. She has exposure keratitis left eye since childhood with severe impairment of vision of the left eye. There is edema both legs. There is pain when turning the head to the right and down. There is weak all muscles both upper limbs more the right. SLRS was 20 degrees with pain right side and 40 degrees with less pain left side. There is weak dorsiflexion both feet -4/5 and planterflexion right foot -4/5. Weak right quadriceps muscle 3/5.

The patient was sent for investigations and MRI cervical spine performed 20-September-2015 showing bulge all disci  with mild retrolisthesis C3-4. MRI dorsal was normal. Lumbar showed spondylolisthesis L4-5 with severe segmental stenosis at L4-5. Chest CT-scan was normal and dynamic studies showed the spondylolisthesis L4-5 and minimal at C3-4.

Transpedicular fixation with reduction of L3-4-5 using XIA 3 system with 6 monoaxial 6.5x45 mm screws with distraction between L4-5 5 mm and L3-4 3mm form the right side. Decompressive laminectomy L3,4 and upper third of L5 with foraminotomy L4 and L5 roots both sides. During decompression a small tear 2 mm at the upper right corner of the L3 level. It was repaired with 6 zero nylon. Check for CSF leak was negative. Using MultiGen , pulsed mode RF with 42 Celsius, 240 sec, 2 Hz and 20 mesec duration both L4 and L5 roots were manipulated.  42 mm cross connector was applied and Lifenet-Health allograft 15 cc mixed with mitted bone harvested from the patient was used and applied lateral to the rods. Routine closure of the wound.

Smooth postoperative recovery. The power of the feet became normal. No sciatica. The patient was sent to the ward.

The patient has multiple problems, among them surgery was needed for the spondylolisthesis L4-5 with severe stenosis at L3-4 and L4-5.

This is the 8th case during which PRF was used.