The patient came to the clinic 07-October-2015 complaining of LBP for 6 years with left sciatica for 3 weeks, not reaching below the left ankle. She is hypertensive for 5 years and diabetic for 5 years under treatment. MRI done 30-September-2015 showed severe LCS L3-4, L4-5 with spondylolisthesis both levels.

On examination: the patient was limping with exaggerated scoliotic stance. She could walk bended anterior with help. SLRS was 75 degrees both sides. Weak dorsiflexion both feet -3/5,, planterflexion both feet 4/5 with numbness both feet.

The patient was sent for investigations and dynamic studies of Lumbar spine done 07-October-2015 showed spondylolisthesis L3-4, L4-5 with severe segmental stenosis at L3-4 and L4-5 with lateral translation of L2-3, L3-4 with scoliotic deformity with Cobb's angle 22 degrees at L3 vertebra. The patient was asked to stop Aspirin and to be seen by cardiologist as preoperative evaluation.

Transpedicular fixation with distraction-reduction of L1-2-3-4-5 using XIA 3 system with 4 polyaxial 6.5x45 mm screws to L2,3 bodies and 6 monoaxial screws 6.5x45 mm to L1,4 and L5 levels. Foraminotomy L4 and L5 roots left side. 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 multiaxial cross connector was applied and melted 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 right foot became normal and considerable improvement of the power of the left foot. No sciatica. The patient was sent to the ward.

The patient has a progressive condition that only surgery can stop her deterioration.

This is the 13th case during which PRF was used to both L4 and L5 roots both sides.