Pediatric spondylolysis and spondylolisthesis present with a wide spectrum of pathology and clinical findings, including back pain, leg pain, crouch gait, or neurological deficit. The treatment of spondylolysis alone is typically conservative with bracing, non-steroidal anti-inflammatory drug, and activity restriction, but refractory pain can be successfully surgically managed with intralaminar compression screw, wires, or pedicle screws with rods and laminar hook constructs. The treatment of dysplastic spondylolisthesis is aggressive to prevent neurological deficit, whereas even high-grade isthmic slips can be treated safely with nonoperative measures if no significant neurological deficits are present. However, patients with higher slip angles tend to progress and require fusion. More long-term data are needed to compare the outcomes of operative versus nonoperative treatment of high-grade slips. Although more evidence will be helpful in guiding surgical treatment, fortunately, the vast majority of these patients are successfully managed nonsurgically.