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Background: Isthmic spondylolisthesis is common in pediatric and adult patients. Most cases are asymptomatic. When symptomatic, nonsurgical treatment is an appropriate first step. Surgical treatment of this condition varies depending on patient age, degree of slip, presence of neurologic findings, and degree of deformity., Purpose: To review the literature on the management of isthmic spondylolisthesis in pediatric and adult patients., Study Design: Review article., Methods: Literature review., Results and Conclusions: Achieving a solid fusion leads to improved functional outcomes and reduction in pain. A circumferential fusion is associated with a higher fusion rate and has become more common, especially with high-grade slips. The need for reduction is controversial and is mostly indicated for patients with significant lumbosacral kyphosis and sagittal imbalance., (Copyright 2010 Elsevier Inc. All rights reserved.)