Clinical Course
49 year old male with pain in both legs walking and standing which was improved with sitting. His leg pain was sciatic nerve in distribution. His treatment consisted of epidural steroid injections, and physical therapy without relief.

Diagnostic Tests
MRI scan showed spondylolisthesis at L4-L5 and lumbar spinal stenosis at that level. A lumbar myelogram and contrast enhanced CAT scan showed compression of the spinal nerves due to the stenosis (narrowing) and the spondylolisthesis due to arthritis in the facet joints.

Decision
A lumbar laminectomy and fusion with instrumentation was offered to the patient.

Surgical Treatment
The surgical treatment consisted of decompression of the spinal canal by removing the roof in the area of compression and then stabilizing the spine with the instrumentation and fusion.

Surgeon's Comment
This patient had tremendous interference in his quality of life. The combination of decompression and fusion and instrumentation is ideal at his age. Instrumentation enhances the fusion rate.