The patient came to the clinic 26-March-2014 complaining of LBP for 3 years with bilateral sciatica, more the left with exacerbation last year. She could walk more than 1 Km and has diabetes mellitus with arterial hypertension and underwent cath 4 stents applied. On examination at that time, she was limping with mild scoliotic stance with SLRS 80 degrees with pain. There was weak dorsiflexion right foot 4/5 and left foot -4/5. Radiologic investigations performed 31-March-2014 showed severe lumbar canal stenosis L45 and less at L3-4 with spondylolisthesis L4-5. The patient was advised for surgical treatment, but she escaped. The patient then came 14-January-2015 with agonizing pain with inability to walk more than 100 meters.

On examination, the patient is in agonizing pain limping with exaggerated scoliotic stance with SLRS 80 degrees with weak dorsiflexion right foot -4/5 and left foot 4/5. The patient was sent for cardio consultation and there was malignant hyperlipidemia which was corrected accordingly. 

Using the C-arm, the level of L4-5 was identified. Skeletonization of L3,4,5 with insertion of 6 screws Medtronic Legacy polyaxial 6.5x45 mm to L3, L4 and L5 bodies with C-arm control. Decompressive laminectomy L4 upper 1/3 of L5 and lower 2/3 of L3 with foraminotomy L4, L5 roots both sides. Inspection of the annulus fibrosis L4-5 left side: no extrusion. Fusion of L3-4-5 with 2 rods 100 mm bended to accept the normal curve of the region with cross connector. The harvested bone melted and applied lateral to the rods. Routine closure of the wound.

Smooth postoperative recovery. The power of the both feet became normal immediately after surgery.

The patient before surgery had apparent spondylolisthesis L4-5 and during surgery there was instability of L3-4 for what L3-4 was included in the fixation and fusion.