There is no general consensus about indications for surgical treatment of degenerative spondylolisthesis. This is--in part--due to a paucity of knowledge of its natural history and outcomes of conservative treatment, as well as a relatively small number of sufficiently powered outcome studies for surgical treatment. We aim to provide an overview of current surgical techniques and deduce indications based on two simple principles: presence of neurological deficits and instability. Today, decompression and instrumented fusion is the standard of care. However, the complete armamentarium of possible treatment options should be carefully considered, and the adequate procedures and instruments used should be chosen individually, when a decision to operate is made.

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