The patient came to the clinic 17-November-2012 complaining of both knees pain for 8 years and difficult standing and walking for 3 years. For more than 4 years, she has shooting pain to the III-V toes right foot.

MRI of the lumbar spine done 10-November-2012 showing II degree spondylolisthesis L4-5 with severe segmental stenosis. Dynamic studies confirmed the overmobility of the spondylolisthesis with isthmolysis.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS 70 degrees both sides with pain. There is weak dorsi and planterflexion both feet 4/5 and hypalgesia both legs below the knees.

Laminectomy of L4 with upper part of L5 and foraminotomy both L4 and L5 roots. There was severe stenosis at L4-5. Discectomy of L4-5 was done with trail to reduce the spondylolisthesis during that. Using Scientex Alphatec Spine - Isobar TTL In System with Novel TL system: Inner nut polyaxial screws 6.2x45 mm were inserted to the L5 body. Inner nut monoaxial screws 6.2x45 mm were inserted to the L4 body. Novel TL, TLIF cage large 7x29 mm was inserted to the disc space from the left with bone graft. Transpedicular fixation with rods 5 mm 30 mm length with slight compression of L4-5 was achieved.

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

The patient still has severe lumbar canal stenosis due to spondylolisthesis of L4-5. Surgery is the only logic solution.