As degenerative changes progress in the aging population, more patients will present with degenerative spondylolisthesis. The clinical picture is usually of a woman older than 50 years of age with a degenerative lumbar spondylolisthesis at L5 with symptoms of neurogenic claudication or radiculopathy. Imaging studies will reveal a central recess, a lateral recess or both, and/or neuroforaminal stenosis. When patients do not respond to nonoperative treatments, surgical intervention is indicated. Most studies have concluded that the addition of an arthrodesis improves the clinical outcome. A recent long-term study showed that a solid fusion and an adequate decompression is the procedure offering the best outcome. The current authors will review the pathogenesis, clinical picture, and treatment recommendations for degenerative lumbar spondylolisthesis.