Irrespective of the use of a dynamic or rigid stabilization system in advanced ages, the biggest problem is screw loosening due to poor bone quality or pseudoarthrosis in fusion surgery. Therefore, it is appropriate to perform the surgery in two stages to increase the chance of success. In the first stage, the screws are placed percutaneously. After 4–6 months, in the second stage, if required, lumbar lordosis is given, and the rods are placed after surgical interventions (such as decompressing the spinal stenosis, expanding the foramen, or removing the pressure on the nervous system). The first stage aims to establish strong osteosynthesis between the screw and the bone to prevent loosening. If the patient has a neurological finding that cannot wait for this period, decompression procedures can be performed at the first stage of the operation, and the possibility of screw loosening can be minimized by placing a temporary rod. In the second stage, temporary rods are placed on all screws on both sides. With the two-stage surgical method, both operations can be performed under spinal anesthesia. A complex surgery can be simplified by performing it in two stages. This can help reduce the mortality and morbidity rates.