High Grade spondylolisthesis L5 S1 This 68 year old female presented to us with back pain and severe radiating pain in both lower limbs with tingling for last 2 years. She had undergone Total Knee replacement few years back. Her Knees were perfectly fine but walking was severly restricted due to Back pain and pain going into legs. Her MRI showed L5 S1 Grade 2 Spondylolisthesis with significant foraminal stenosis. She had been doing physiotherapy for last 2 years but there was no releif. Her walking and standing time was hardly 10 mins. She underwent L4 To S1 decompression and Pedicle screw fixation and TLIF at L5 S1. She was kept in ICU for 1 day and then shifted to ward. From day 2 physiotherapy was started and she was discharged after 5 days. There was significant improvemnt in walking and standing time over next 2 months and her quality of life had significantly improved.