Spondylolisthesis is a description of the translation of one vertebra over another. Though most commonly seen in the degenerative setting, oncologic involvement of the posterior elements, notably the facet joints, can result in a pathologic spondylolisthesis. Similar to isthmic spondylolisthesis, pathologic spondylolisthesis is generally unstable and require surgery to address the underlying instability. However, extensive neoplastic involvement of the affected level may complicate correction by hindering the surgeon’s ability to place instrumentation with good purchase. In this chapter, we examine the mechanisms and management of pathologic spondylolisthesis in the setting of oncologic disease.