Degenerative spondylolisthesis is the displacement of one vertebral body over another. In clinical practice, it is a common finding associated with degenerative changes in the spine, which in some cases can translate into low back pain and neurologic symptoms such as radiculopathy due to foraminal stenosis. Spondylolysis consists of a defect in the pars interarticularis, which is sometimes associated with listhesis of the vertebral bodies, especially in younger patients or after trauma. Due to the high prevalence of these conditions, spine surgeons should be familiar with the natural history and management of spondylolisthesis. Surgical management of these conditions is often necessary when conservative management fails. The advancement in the field of spine surgery now allows various surgical techniques to be applied to cases of spondylolisthesis, and surgical pearls emphasize the importance of well-considered approaches. In this chapter, we will discuss both conservative and surgical options aimed at improving patients’ quality of life, guided by clinical evaluation and imaging findings.