The patient came to the clinic 29-October-2013 complaining of LBP for 15 years with numbness both feet for three months with intermittent claudication after walking more than 300 meters.

MRI lumbar spine done 28-October-2013 showing spondylolisthesis L3-4 with severe stenosis at this level with less stenosis at L4-5.

On examination: the patient is limping with no scoliotic stance. SLRS was 80 degrees with tightness in the left. No motor deficit but dyseasthesia both L5 roots territories.

Laminectomy L3, L4 done. Foraminotomy both L4 roots. Discectomy of L3-4 was done from the left side with insertion of TLIF cage Novel TL  9x23x5 mm with bone graft. The lateral masses of L3-4 were fractured both sides. All the compressive elements were removed at L4-5. Using Isobar TTL module in monoaxial screws 6.2x45 mm were inserted to L3 and 6.2x45 polyaxial screws to L4. All stages of surgery were performed with C-arm. 2 bended rods 5.5x60 mm and cross connector were used to obtain transpedicular screw fixation with slight compression. Bone graft was used lateral to the rods. Routine closure of the wound.

Smooth postoperative recovery. 

The patient had trauma to the lateral masses of L3-4 which caused the spondylolisthetic changes.