Spondylolisthesis is defined as the forward translation of one vertebra on another in the sagittal plane. There are multiple etiologies of spondylolisthesis, including the degenerative and postsurgical varieties. Degenerative spondylolisthesis presents in a more elderly population and usually involves the lumbar fourth and fifth vertebrae. The pathogenesis is believed to be secondary to the progressive degeneration of the disc and facets, which results in instability and pathologic segmental motion. Clinically, patients present with low back pain and neurological symptoms consisting of spinal claudication or radiculopathy. A postsurgical spondylolisthesis is often the inevitable result of decompression with up to 50% of patients developing late instability that requires stabilization. Similar to a degenerative spondylolisthesis, these patients will present with reoccurrence of radicular pain associated with increasing low back pain. A spondylolisthesis is identified with plain radiographs, which should include flexion and extension to identify pathologic motion. An MRI is useful for the evaluation of stenosis, while a Myelo/CT with flexion and extension weight-bearing views is superior for the evaluation of dynamic instability. Nonoperative treatment consists of bracing, nonsteroidal antiinflammatory medication, epidural blocks, weight reduction, and physical therapy. Surgical indications include severe back pain or neurological symptoms. Following decompression, an arthrodesis is recommended for a degenerative spondylolisthesis since long-term studies have demonstrated improved outcomes. A postsurgical spondylolisthesis, by definition, is unstable and requires a concurrent stabilization. Surgical options include posterior pedicular rod and screw fixation, posteriorly placed interbody implants combined with pedicular instrumentation, or combined anterior and posterior procedures. Materials available for fusion include autograft, allograft, or new biologic graft substitutes such as rhBMP-2. This article reviews the etiology and pathogenesis of spondylolisthesis along with recommended treatment options and surgical techniques to enable clinicians to insure superior patient treatment outcomes.