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The results of posterolateral screw fixation using the Buck technique performed on 24 patients with painful isthmic spondylolysis and up to grade I spondylolisthesis in the lumbar spine are reported. The average age at operation was 29 years and average follow-up was 5 years with a range of 13 months to 12 years. Operations were performed for persistent disabling low back pain. At review 21 patients were either free of pain or complained of only occasional backache and discomfort. All but two patients were satisfied with the operation and rated the result as excellent or good. It is concluded that Buck screw fixation is a safe and reliable method of treatment for painful Grade I spondylolisthesis due to isthmic spondylolysis in the young active adult with a low complication rate.