Fig. 1

Graphic illustration of the operative process. A The L5-S1 level was identified, and the anterior longitudinal ligament, annulus fibrosis, and partial disc were removed. B First cantilever: open anterior disc space. C Complete discectomy and endplate preparation. D The disc space was dilated, the foramen height was restored, and the posterior facet joints were open or mobilised by the trial cage. E The Cobb elevator blade was placed into the posterior surface of the sacral dome as a hinge. F Second cantilever: the posterior elements were released, and spondylolisthesis was reduced. G Anterior lumbar inter-body fusion. H Supplemented with posterior instrumentation using the Wiltse approach