The patient came to the clinic 19-May-2015 complaining of LBP for 20 years with exacerbation of right sciatica 2 months down to the right knee. MRI lumbar spine done 20-April-2015 showing extruded disc L2-3 (Lumbarization of S1). The patient is a known diabetic with arterial hypertension.

On examination; the patient is limping with exaggerated scoliotic stance. Neck and upper limbs were neurologically free. SLRS was 5 degrees with pain right and 85 degrees in the left. There is weak dorsiflexion right foot 3/5. The right AJ is absent.

The patient was sent for investigations and MRI performed 25-May-2015 showing huge extruded disc L2-3 with right downward migration. Dynamic studies showing I degree spondylolisthesis L2-3.

Using the C-arm, the level of L2-3 was identified and skeletonization of L2, 3 was performed. Using Legacy M.A. 4 screws were inserted to L and L3. Using Neuro N50 monopolar stimulation using TCU 415 15 cm, 10 mm, the direct root stimulation was achieved with 1.5 mV The right upper and both lower screws gave response at 8 mV response. The left upper gave response with 2.5 mV. Despite the fact that the screw was in good position, it was decided to explore the screw cavity with feeler, which showed no penetrations at its walls. Another screw was reinserted more lateral with 7.5x45 mm. After that the current of 4.5 was showing slight response.  Hemilaminectomy of L2-3 with foraminotomy right L3 root. The extruded disc was removed lateral to the axilla and right sided cleaning of the disc space of L2-3 was achieved. 2 bended rods and cross connector were applied to achieve fusion of L2-3. Routine closure of the wound.

Smooth postoperative recovery. The power of right foot became normal.

The patient has spondylolisthesis and extruded disc, both problems must be corrected.