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Adult high-grade degenerative spondylolisthesis represents the extreme end of the spectrum for spondylolisthesis and is consequently rarely encountered. Surgical management of high-grade spondylolisthesis requires constructs capable of resisting the shear forces at the slipped L5-S1 interspace. The severity of the slip, sacral inclination, and slip angle may make conventional approaches to 360 degrees fusion difficult or hazardous. Transdiscal pedicle screw fixation, transvertebral fibularpmid:16599423 fatcat:qqawzjwdw5golou6oyzguv6fx4