The patient came to the clinic 01-February-2015 complaining of LBP with numbness right leg for 4 months. The patient is diabetic for 3 years, underwent surgery for PLD L4-5 2006 and 2013 for the right sciatica. MRI done 14-September-2013 before the second surgery, showing recurrent PLD L4-5 right side with right foraminal occlusion. MRI lumbar spine done 21-September-2013 with CT-scan after the second surgery showing showing transpedicular fixation L4-5 and S1 right side.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS 60 degrees right side with 40 degrees in the left with pain. There is weak dorsi and planterflexion left foot 4/5 and weak dorsiflexion right foot -4/5 with dyseasthesia right L5  and analgesia right L5 and S1 territories.

The patient was sent for investigations and MRI done 28-February-2015 ruling out the presence of active infection, nor new disc extrusion. CT-scan done 01-March-2015 showing the screws in position, but there is scoliosis, which needs correction.

The old incision refreshed and the nuts of the transpedicular screws identified and they are movable as a whole but the screws are acceptable. The rod was removed. Insertion of transpedicular screws to L4. L5 and S1 levels identical to those inserted to the right using Medtronic Legacy MAS 2 screws 6.5x45 mm to L4 and L5 and 6.5x40 mm to S1. 2 rods 110 mm inserted and distraction of the right side to correct the scoliotic deformity. Cross connector was applied. Routine closure of the wound.

Smooth postoperative recovery. The power of both feet became normal.

Unilateral fixation of the spine is non sense. It is as putting the image in the DICOM without MPR. Nature and God like symmetry. This example support this finding.