This article reviews the assessment and management of degenerative spondylolisthesis and lumbar stenosis. It discusses nonoperative management modalities and operative management and indications. It also discusses complications and reviews the current body of literature for clinical outcomes with surgical management. There remains conflicting evidence on whether isolated decompression versus decompression and fusion is superior,. Minimally invasive techniques show early promise at reducing some of the potential complications with open decompression. As health care costs increase, cost considerations become more important and should be included as a factor in decision making.