The patient came to the clinic 26-July-2004 complaining of LBP with bilateral sciatica more to the right with numbness of both feet and inability to walk more than 100 meters. The patient is hypertensive for 2 months without medication.

MRI lumbar spine done 22-July-2004 showing severe stenosis L4-5 with I degree spondylolisthesis and extruded disc L5-S1 with foraminal occlusion.

On examination: The patient is limping with exaggerated scoliotic stance. SLRS was 90 degrees in both sides. There is weak dorsiflexion both feet -4/5.

Decompressive laminectomy L4 and L5 with foraminotomy both L5 and both S1 roots was done. The extruded disc of L5-S1 was inspected and not removed because it was hard, immobile. The right S1 root was decompressed of all surrounding elements. Check for instability was negative. The subcutaneous fat was harvested with pedicle and transferred to the dura to decrease the postoperative scar formation.

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

The patient came to the clinic 07-August-2004 with clean wound and no motor deficit. SLRS was 90 degrees both sides without pain. There is hypalgesia right L5 root territory.

The patient came 22-August-2007 complaining of LBP for 2 months with MRI lumbar spine performed 19-August-2007 showing spondylolisthesis L4-5. She has osteoporosis. She was neurologically free and treated conservatively.

The patient then came 11-December-2011 telling that she cannot walk the last 3 months due to LBP and right sciatica and numbness right foot. after trauma to the right ankle with edema.  The patient was sent for investigations. MRI dorsal spine showing multiple bulges, so the cervical spine. Dynamic studies confirmed presence of spondylolisthesis L4-5 II degree. She was advised to undergo transpedicular fixation of L4-5 and given admission, but she disappeared.

She came 03-April-2013 telling that she was operated at Jordan hospital 1 week after last visit without benefit. MRI lumbar done 31-March-2013 showing the same data as before and no fixation was done. She is using crutches the last week  and walking with help. SLRS was 80 degrees with pain right side with weak dorsiflexion right foot 3/5 and 4/5 left foot and weak planterflexion right foot 4/5. The patient came several times and every time more deterioration of her neurologic status until she progressed drop left foot and hypalgesia below both knees.

The old degenerative extruded disc of L5-S1 was left untouched because there was no necessity to remove it.

The spondylolisthesis of L4-5 is still difficult to estimate its role in the clinical setup. Time will tell.