The patient is placed under general anesthesia. Positioning is typically prone (face down) on the operating table, ensuring proper spine alignment and access to the surgical site. The surgeon makes an incision over the affected area in the lower back. Muscles and soft tissues are carefully retracted to expose the spine.

• Decompression Laminectomy: The lamina (the roof of the spinal canal) of the affected vertebra(e) is removed. This process enlarges the spinal canal to relieve pressure on the spinal cord and nerve roots. Additional decompression procedures, such as foraminotomy (widening the nerve root exit spaces) or discectomy (removal of disc material), may be performed if necessary.

• Fusion Process: After decompression, the surgeon prepares the adjacent vertebral bodies to receive the bone graft material. This usually involves roughening the endplates to promote bone growth. Bone graft, which can be autograft (from the patient), allograft (donor bone), or synthetic bone substitutes, is placed in the intervertebral space and along the posterior aspect of the vertebrae. Pedicle screws and rods are often used to stabilize the spine and maintain proper alignment immediately. In some cases, interbody cages may be inserted into the disc space for additional support and to help maintain the normal height of the intervertebral space. Once the fusion hardware is in place, the muscle and soft tissues are repositioned, and the incision is closed with sutures or staples.

The procedure can significantly reduce pain and improve function by decompressing the spinal nerves and stabilizing the spine. The fusion prevents further slippage of the vertebrae, halting the progression of spondylolisthesis. The surgery aims to restore normal spinal alignment, improving posture and reducing strain on the spinal structures.