The patient came to the clinic 08-July-2014 complaining of LBP for 30 years after falling down and fracture of D12. She got exacerbation of the LBP the last year with right sciatica for for 5 months and drop right foot the last 2 months with numbness both feet. MRI lumbar spine done done 06-July-2014 showing severe lumbar canal stenosis L3-4, L4-5, L5-S1 with spondylolisthesis L4-5 and L5-S1 with the old wedged fracture of D12.

On examination; the patient using crutches and walking with the help of one person. There is severe scoliotic deformity. SLRS was 70 degrees with pain in the right and 80 degrees in the left. There is almost drop right foot with weak dorsiflexion left foot 3/5. Weak planterflexion both feet 4/5. There is severe O.A. changes both knees with pain of the right knee.

Skeletonization of L3,4,5 and upper sacrum both sides until the lateral masses of L3-4, 4-5, L5-S1 were exposed both sides. The lateral masses of L5-S1 were fused and stable. Laminectomy of L3,4 and upper 1/3 of L5. All the stenotic elements were removed and foraminotomy both L5 roots was achieved. The dura was so thin and transparent and adherent to the ligamentum flavum, that during careful dissection a pin-point dura defect was seen at L4-5 level, which was closed using nylon 6 zero and elevation of the head with Valsalva maneuver was applied and no CSF leak was noted. The L4-5 level was unstable, for what fusion of L4-5 was done using 4 polyaxial Xia 3 45x6.5 mm transpedicular screws and 2 bended rods with cross connector. The harvested bone was melt and added lateral to the rods. Routine closure of the wound.

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

The L5-S1 spondylolisthesis was noted included in the fusion, because it was stable from the posterior elements, t.e., ossified and fused lateral masses.

All the elements causing the severe lumbar canal stenosis were removed. Check for instability was performed even after the performed laminectomies.

Fusion was applied only to the mobile segments.