The patient came to the clinic 23-October-2011 complaining of LBP for 2 years with bilateral sciatica more the right down to toes both feet. The patient performed MRI lumbar spine  15-June-2011 in Yemen showing spondylolisthesis L4-5 with complete stenosis at this level.

On examination: the patient is limping with exaggerated scoliotic stance. There is weak dorsi and planterflexion both feet -4/5.

The patient was sent to new MRI and CT-scan investigations with dynamic LSS X-ray which confirmed the presence of II degree spondylolisthesis and complete stenosis at this level.

Partial laminectomy L4 and L5. Foraminotomy both L5 roots with more extension to the right side. Discectomy L4-5 from the right. Traxis TILF PEEK cage 9x9x21 mm with NovaBone putty 0.5 cc inserted to the L4-5 disc space from the right. Two monoaxial screws Zimmer 6.5x45 mm inserted to the L5 body. Two polyaxial pedicle screws 5.5x45 mm inserted to L4 body. 50 mm rods were bended slightly and used to fuse the L4 and L5 bodies with 5.5 62 mm length transverse connector to bring more stability to the construct with slight compression. Check for instability or loosening. All stages of surgery were under the control of C-arm.

Routine closure of the wound.  Smooth postoperative recovery with improvement of the power of both feet.

The patient has unstable back with complete stenosis. Spondylolisthesis must be fused with TILF after decompressing all the neural structures.