Spondylolisthesis is the forward displacement of one vertebra over another, most commonly occurring at L5-S1. It occurs due to defects in the bone check mechanism at the lumbar-sacral junction that normally prevents slippage. The majority of cases are isthmic, resulting from a stress fracture or lesion of the pars interarticularis due to repeated flexion/extension stresses. Patients typically present with low back pain aggravated by extension and relieved by flexion. Radiographs reveal the degree of slippage and any pars defects. Treatment involves conservative care for mild cases and surgery to repair defects, reduce slippage, and fuse vertebrae for more severe or progressive cases.