The patient came to the clinic 17-July-2012 complaining of LBP for 5 years with left sciatica for 2 years. She cannot walk more than 100 meters due to pain. The patient is known hypertensive under treatment.

On examination, the patient is limping with exaggerated scoliotic stance. SLRS was 80 degrees in right side and 30 degrees in the left pain. There is weak dorsiflexion right foot 4/5, left foot 3/5 and planterflexion left foot 4/5. The knee jerk is absent in the right. The patient claiming that she has hypalgesia below the left nipple down.

The patient was sent for MRI investigation and done 23-July-2012 showing normal dorsal spine MRI and severe stenosis L3-4 and L4-5. There is spondylolisthesis L3-4 and extruded disc L4-5 with left foraminal occlusion.

Laminectomy of L4 and upper half of L5 and lower 2/3 of L3 with foraminotomy L4, L5 roots both sides. The extruded disc L4-5 was approached from the left side and discectomy of L4-5 was done. Discectomy of L3-4 was also performed and insertion of TLIF cages 9x10x28 mm was achieved to both levels with bone graft. Using Scientex IsoBar TTL system with polyaxial screws 6.2x45 inserted to L5 and L3 bodies and monoaxial same dimensions to L4 body. Rods bended to accept the natural curve of the spine 5.5 mm thickness with cross connector were used to fuse L3,4 and L5 bodies. ISIS stimulation was used and the roots were responding to 2-4 mA DNS, but the screws were not responding even to 15 mA.  Bone graft was aided lateral to the rods.

Routine closure of the wound. Smooth postoperative recovery. The power of both feet became better.

The patient have spondylolisthesis, extruded disc and lumbar canal stenosis. All need surgical correction.