Spondylolisthesis is a condition seen in pediatric and adolescent athletes involved in sports that require hyperextension of the lumbar spine. Symptoms can range from none to low back pain, radiculopathy, and hamstring tightness. Spondylolisthesis occurs when a defect in the pars interarticularis leads to anterior displacement of the vertebral body. Low-grade spondylolisthesis (less than 50% slip) is typically managed with conservative treatment, while high-grade spondylolisthesis (greater than 50% slip) often is treated with surgery. Surgery for high-grade cases has been shown to improve health-related quality of life. Value can be enhanced by applying evidence-based practices to reduce complications and minimize the risk of reoperation.