Lumbar spondylolisthesis in adolescents is not uncommon clinically, but there are fewer symptomatic cases. However, because adolescents are in a stage of rapid growth and development, if not handled properly, the slippage can be further aggravated and even severe lumbar slippage can occur, causing symptoms of neurological damage such as urinary and fecal dysfunction. In order to improve the understanding of this disease, the author makes a brief analysis of some problems of lumbar spondylolisthesis in adolescents. The pathological mechanism of lumbar spondylolisthesis in adolescents The mechanism of lumbar spondylolisthesis in adolescents is not very clear, and most of them are dysplastic and isthmic fracture type. Studies have shown that in an upright position, the weight of the upper trunk is mainly transmitted from L5 to the lower extremities, and due to the presence of the lumbosacral angle, the L5 vertebrae are subjected to a large shear force forward and downward, and normal posterior vertebral structures can share some of the shear force, but lumbar spondylolisthesis may occur when the posterior vertebral structures are damaged due to congenital dysplasia or various reasons, such as isthmic discontinuity. After lumbar spine slippage, the axial force line of the spine is changed, the center of gravity of the trunk is shifted forward, and the compensatory increase in lumbar foreshortening further increases the shear force on the vertebral body, forming a vicious circle, so that the degree of lumbar spine slippage increases continuously and even develops into severe lumbar spine slippage. After lumbar spine slippage, due to lumbar instability, intervertebral disc structure destruction, small joint hyperplasia, spinal canal volume reduction and other reasons, causing symptoms such as low back pain, lower limb radiating pain, intermittent claudication, etc. Serious cases can involve the cauda equina nerve, causing saddle area numbness, urinary and fecal dysfunction. The relationship between symptoms of lumbar spondylolisthesis and spinal-pelvic parameters In recent years, some scholars have measured spinal-pelvic parameters such as pelvic incidence angle and lumbar anterior convexity angle, trying to find out the relationship between spinal-pelvic parameters and the degree of lumbar spondylolisthesis and patients’ symptoms Labelle et al. and Boulay et al. pointed out that the pelvic incidence angle was significantly and positively correlated with the degree of lumbar spondylolisthesis, and Lu et al. considered that the pelvic tilt angle, lumbar anterior convexity angle, C7 plumb line-sacral posterior angle distance, and hip-S1 horizontal distance were significantly positively correlated with lumbar pain symptoms, and sacral tilt angle and hip-S1 vertical distance were significantly negatively correlated with lumbar pain symptoms. Patients with more severe slippage may develop abnormal posture due to N cord muscle spasm, which is manifested by flexion of the hip and knee joints when standing or walking. Treatment options for lumbar spondylolisthesis in adolescents Lumbar spondylolisthesis in adolescents is mostly mild, with no obvious clinical symptoms, and a few patients may have symptoms such as low back pain and radiating pain in the lower extremities, the extent of which is related to the patient’s activity. Those with no obvious symptoms generally do not need special treatment, and regular X-ray examination is sufficient. For patients with mild clinical symptoms, most of them can achieve good results through conservative treatment such as wearing braces, low back and abdominal muscle exercises. Patients whose symptoms are not relieved by systematic non-surgical treatment and whose slippage progresses, as well as those with combined neurological symptoms, should be treated surgically. In patients with mild isthmic fissure-type slippage, without obvious disc degeneration and neurological symptoms, isthmic fissure repair is feasible; the advantage of this technique is to restore the bony connection to the disconnected isthmus, thus maximizing the restoration of the anatomical structure and preserving the mobility of the diseased segment. For those with symptoms of neurological compression, decompression and fusion fixation should be performed. Surgical treatment of severe lumbar spondylolisthesis in adolescents Lumbar spondylolisthesis in adolescents rarely develops into severe lumbar spondylolisthesis, but once it occurs, it requires surgical treatment, which in principle can be compared to severe lumbar spondylolisthesis in adults. The main purpose of surgical treatment is to relieve the nerve compression, correct the deformity and rebuild the stability of the lumbar spine, and prevent the progression of the slippage. Adequate and effective decompression is a prerequisite for reducing the patient’s symptoms and obtaining good results. However, there are still different opinions on whether the slipped vertebrae need to be repositioned. Some studies have shown that in situ fusion fixation of slipped vertebrae based on adequate decompression can achieve good long-term outcomes, while intraoperative resetting may increase the incidence of complications such as nerve root injury. However, some scholars believe that repositioning of patients with severe lumbar spine slippage does not increase the incidence of complications such as nerve injury, and that repositioning can restore the physiological curvature of the patient’s lumbar spine, correct the deformity, and bring the biomechanical environment of the lumbar spine closer to the physiological level, while the long-term efficacy of in situ fixation is unreliable. The author believes that patients with severe lumbar spondylolisthesis should be repositioned as much as possible to correct the deformity and restore the spinal sequence to a certain extent, so that the spinal force line is closer to the normal level, which not only reduces the shear force on the slipped vertebrae, but also delays the degeneration of the adjacent segments. Because of the severe spinal deformity in patients with severe lumbar spondylolisthesis, care should be taken when resetting, and complete resetting should not be forced, especially in patients with dysplastic lumbar spondylolisthesis, where special attention should be paid to avoid damaging the nerves. For patients with severe lumbar spondylolisthesis in which the L5 vertebra has completely slipped in front of the S1 vertebra, the slipped L5 vertebra can be removed and the L4 vertebra can be fused directly with the S1 vertebra to improve the lumbar force line and reduce nerve root injury. After decompression and repositioning, fusion fixation is required to maintain long-term spinal stability. At present, the methods of implant fusion mainly include anterior fusion and posterior fusion, among which posterior intervertebral implant fusion combined with pedicle screw internal fixation is more widely carried out in China, with more mature technology and precise clinical effect. Some scholars also use the combined anterior-posterior approach 360° fusion to treat severe lumbar spondylolisthesis and obtain better clinical results. The author believes that the combined anterior-posterior approach is long, traumatic and bleeding, so it is not recommended for routine application. The combined anterior-posterior approach is feasible for patients with greater slippage displacement, severe spinal deformity and extreme instability in order to improve the fixation strength and fusion rate. In conclusion, the clinical manifestations of lumbar spondylolisthesis in adolescents vary widely, and the specific treatment varies. Spine surgeons can develop the most appropriate individualized treatment plan based on their own skill level and the patient’s actual condition.