The patient came to the clinic 26-February-2012 complaining of LBP for 15 years with bilateral sciatica more the right with exacerbation last 6 months with neck and left shoulder pain. The patient was treated conservatively and came several times. The patient then came 17-September-2013 complaining of exacerbation of LBP with bilateral sciatica more the right with numbness both feet and inability to walk more than 100 meters the last 6 months.

On examination: the patient is limping with exaggerated scoliotic stance. SLRS was 60 degrees with pain both sides. There is weak dorsiflexion both feet 4/5 with hypalgesia both L5 territories and planterflexion right foot 4/5.

MRI lumbar spine done 26-September-2013 showing II-III degree spondylolisthesis L5-S1 with severe stenosis at this level.

Laminectomy L4, L5 and upper part of the sacrum. Foraminotomy both S1 roots. The disc space of L5-S1 was shallow, but to perform reduction a TLIF cage Novel TL 6x23x10 mm inserted to the disc space from the right. Transpedicular fixation Isobar TTL module in was done at L4, 5 and S1. A reduction screw 6.2x45 was used to L5 body. Polyaxial  6.2x35 mm to S1 and monoaxial 6.2x45 to L4 level. 2 bended rods 5.5x60 mm and cross connector were used to fuse L4,5 and S1 levels.  All stages of surgery were done with the use of C-arm. Bone graft was added lateral to the rods. Routine closure of the wound.

Smooth postoperative recovery.

The patient has unstable spondylolisthesis L5-S1 with more than II degree. Reduction is better done with the inclusion of L4.