Spondylolisthesis is a spinal disorder characterized by anterior or posterior displacement of one vertebral body relative to the adjacent level. It may be congenital, isthmic, degenerative, traumatic, or pathological in origin. Progressive vertebral slippage can result in spinal instability, neural compression, and chronic pain, necessitating neurosurgical evaluation in symptomatic patients.

Patients commonly present with mechanical low back pain exacerbated by activity, along with radicular leg pain, numbness, or weakness due to nerve root compression. In advanced cases, spinal canal narrowing may produce neurogenic claudication or progressive neurological deficits. The severity of symptoms does not always correlate directly with the degree of slippage, underscoring the importance of comprehensive clinical assessment.

Diagnostic evaluation includes standing radiographs to assess vertebral alignment and dynamic instability, complemented by MRI to evaluate neural compression and disc degeneration. CT imaging may assist in defining pars defects or bony anatomy. Accurate classification informs prognosis and surgical planning.

Initial management may be conservative in patients with mild symptoms and stable slips. Surgical intervention is indicated in cases of persistent pain refractory to conservative therapy, progressive neurological deficits, or radiographic instability with functional impairment. The goals of surgery are neural decompression, stabilization of the affected segment, and restoration of spinal alignment.

Surgical strategies often combine decompression with instrumented fusion to address both neural compression and instability. Technique selection is individualized based on pathology, patient factors, and functional goals. Postoperative care emphasizes mobilization, rehabilitation, and long-term spine protection.

Spondylolisthesis requiring surgery is a biomechanically complex condition where precise neurosurgical intervention can provide durable symptom relief and prevent further neurological compromise.