The patient came to the clinic 13-October-2012 complaining of LBP for three years, bilateral sciatica and numbness of both feet more the right for one month. Cannot walk more than 100 meters due to pain with positive cough sign. The patient is hypertensive for 15 years and cath done 2010 which was normal. The patient had RTA 6 years ago.

MRI lumbar spine done 18-September-2009 showing spondylolisthesis L4-5 with secondary stenosis and bulge L5-S1.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 75 degrees both sides with pain in the right. There is weak dorsiflexion both feet -4/5 and the right foot planterflexion 4/5. There is hypalgesia right L5 and S1 roots.

New MRI lumbar spine requested and done 04-November-2012 showing II degree spondylolisthesis L4-5 with complete stenosis at this segment with bulge L5-S1.

Decompressive laminectomy L4 and partial of L5. Foraminotomy both L5 roots. Right L4-5 discectomy with insertion of TLIF cage Novel TL 9x24x15 mm with bone graft. Using Isobar pedicular screw system- Scientex 6.2x40 mm ployaxial screws were inserted to the L5 pedicles and 6.2x40 mm monoaxial to the L4 pedicles. 2 rods 5.5x65 mm and cross connector were used with slight compression to fuse the L4-5 level. Bone graft Lifeline was used parallel to the rods.

Routine closure of the wound. Smooth postoperative recovery. The power of the feet became normal and the right sciatica disappeared.

The patient has severe lumbar canal stenosis due to spondylolisthesis L4-5 with progressive course. Surgical correction both problems is the only solution.