The patient came to the Emergency of Shmaisani hospital 12-August-2014 complaining of LBP for 1 year  with right sciatica for 1 month.

On examination; the patient is in agonizing pain, limping with exaggerated scoliotic stance. SLRS was 30 degrees with pain in the right and 50 degrees in the left. There is weak dorsiflexion right foot 2/5 and planterflexion same foot 4/5. There is analgesia of the right leg below the knee.

The patient was sent for investigations and MRI lumbar spine done 12-August-2014 showing extruded disc L4-5 with spondylolisthesis L4-5 with severe segmental stenosis. Dynamic studies confirming this.

Bilateral L4-5 flavotomy and foraminotomy both L5 roots. The extruded disc was removed from both sides and bilateral intradiscal cleaning L4-5 disc space. Insertion of TL cage 11x25x4 with bone graft from the left side. Using XIA 3 system, transpedicular fixation was achieved between L4 and L5 bodies. 4 monoaxial 6.5x45 mm screws with Mac cross connector 42 mm were used with bended rods. All stages of surgery were guided with C-arm and the last AP view showed unacceptable right rod position, for what it was repositioned up 10 mm. Slight compression was applied. The milted bone graft was put lateral to the rods. Routine closure of the wound.

Smooth postoperative recovery with dramatic improvement of the power of right foot.

The patient has extruded disc with spondylolisthesis and severe stenosis. All these data were corrected.