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This chapter discusses the possibility of an anterior approach to the lumbar spine and application of the reverse Bohlman technique, combined with the use of robotic guidance to perform posterior transdiscal S1-L5 screw fixation within the context of high-grade spondylolisthesis with preserved sagittal balance. Possibilities and limitations of this concept are discussed, the benefit of robotic guidance is outlined, and a patient vignette is provided for illustration. Robotic spine surgery high-grade spondylolisthesis reverse Bohlman procedure transdiscal S1-L5 screw fixation robotic guidance Spondylolisthesis is a common condition, where forward slippage of one over another vertebra leads to mechanical low back pain and/or radicular leg pain in case of foraminal stenosis.