Background: Assessing the clinical, functional, and radiological results of transforaminal lumbar interbody fusion (TILF) with OPAL spacer system cage and expedium 5.5 titanium screw system for low grade spondylolisthesis (Grade I, II). Method: At the Aswan University Hospital at EGYPT, we evaluated 30 patients who had surgery between June 2018 and October 2022. The expedium 5.5 titanium system and OPAL cages were used throughout the operations on all patients. The surgery was performed at L4-5 level in 17cases and at L5-S1 level in 13 cases. For all patients, a simple lumbosacral spine X-ray with dynamic films for preoperative and postoperative follow-up as well as an MRI of the lumbosacral spine were performed. The Visual Analogue Scale (VAS) and the Oswestry Disability Index (ODI) were used to measure the clinical and functional outcomes. The median follow up was 11 months. Results: At the OPAL cages one-year follow-up, satisfactory fusion was achieved at all levels. With our method of decompression, there were no dural tears or any intraoperative problems, and the fusion rate was 96.66% (29 patients). A follow-up with OPAL cages showed a higher fusion rate, improved realignment, and reduced resorption. Conclusion: With minimal side effects, TILF using OPAL cages and the expeduim screw system has produced better clinical outcomes and higher rates of circumferential fusion. OPAL cages stabilize spinal segments primarily by distracting them and facilitating bone fusion and ingrowth. They also help to distract the space between vertebral bodies, which facilitates spondylolisthesis correction.