Spondylolisthesis is a common condition that can be managed both nonsurgically and surgically. More than 80% of children treated nonsurgically have resolution of symptoms. For those patients requiring surgical treatment, fusion in situ may provide adequate treatment for young patients. Patients with neural compression may require decompression to relieve symptoms, and fusion is also usually indicated. High-grade and degenerative spondylolisthesis require care that is unique to those conditions. Spondylolysis is a defect in the pars interarticularis that occurs in approximately 5% of the general population. Approximately 15% of individuals with a pars interarticularis lesion have progression to spondylolisthesis.