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Since the chances for further slipping of the vertebrae is higher for younger children, it is important for them to be followed carefully by a health care provider until they reach skeletal maturity. Grades I and II slippage are usually treated with conservative treatment (as with spondylolysis) but may require additional intervention including:

• X-rays every 3-6 months to check for progression of slip for children before skeletal maturity
• Analgesic medications to relieve pain
• Rigid bracing or body cast
• Intensive physical therapy to strengthen the back and abdominal muscles
• Exercise program to stretch hamstring muscles
• Period of resting and abstaining from sports
• Weight loss with maintenance of ideal weight

A child who has low-grade spondylolisthesis can return to sports, although certain sports (e.g., gymnastics and weight lifting) may exacerbate the patient's prior symptoms. If pain does not improve with nonsurgical, conservative treatment, surgery may have to be considered. The younger the age of onset, the greater the risk for progression, and these patients should be monitored on a periodic basis even if the initial symptoms resolve. Skeletally immature persons with slippage greater that 30-50% are at increased risk for progression. Routine follow-up is necessary to monitor slip progression every 3-6 months. It has been estimated that up to 50% of individuals with Grade II spondylolisthesis will eventually require surgery.

If an adolescent develops spondylolisthesis due to an acute injury, there has been some success reported by placing the patient in a custom-made orthosis with the lumbar spine in extension for 2 to 3 months to achieve healing of the fracture and relieve symptoms. However, the effectiveness of orthosis remains an area of debate.