Spondylolisthesis is a medical diagnosis indicating that one of the spinal vertebrae has moved out of its normal position and is pressing on the vertebrae below it. This misalignment or slippage of the vertebrae can also put pressure on nearby nerves causing back or neck pain, stiffness, diminished range of motion, and other symptoms. While spondylolisthesis can happen anywhere along the spine, it is most common in the lumbar region (low back).
There is a grading system for spondylolisthesis called the Meyerding Classification system. A radiologist reviewing the patient’s diagnostic imaging will grade the spondylolisthesis depending on the severity of the vertebral slippage. Imaging may include x-rays, CT scans, or an MRI. Grades of severity range from 1 to 5.
Grade 1
A Grade 1 diagnosis indicates the vertebrae has slipped less than 25%. This is considered a low-grade spondylolisthesis. Patients may be asymptomatic or may have mild symptoms such as back or neck pain, stiffness, and pain that radiates down an arm or leg, depending on where the spondylolisthesis is located. If a nerve is irritated, there may be numbness or tingling in the extremity.
The L4 and L5 vertebrae in the low back are commonly affected, particularly in older adults with osteoporosis or other degenerative changes in their joints or discs. Treatment at this stage is most often conservative including rest, ice and heat therapy, activity modification, anti-inflammatory pain medication, physical therapy, and bracing.
Grade 2
This diagnosis indicates a slippage of 25-50% and is also considered to be low-grade. Symptoms may range from mild to moderate. Treatment is usually conservative. Most patients will not need surgery.
Grade 3
Grade 3 indicates a 50-75% slippage of the vertebrae. This is classified as high-grade spondylolisthesis. Symptoms will be more severe and may affect the patient’s ability to stand or walk. A spinal fusion may be necessary to stabilize the spine. Decompression surgery may be needed to remove pressure from the affected nerve.
Grade 4
Grade 4 indicates a slippage of more than 75%, which is considered high-grade. Symptoms are severe, with chronic pain and significant nerve compression. Grade 4 spondylolisthesis usually requires surgery.
Grade 5
The vertebrae has completely slipped off of the vertebrae below it. Surgery is required to realign the vertebrae and stabilize the spine.
Atlanta Brain and Spine Care
The specialists at Atlanta Brain and Spine Care are experts in the treatment and care of spondylolisthesis. Contact us to schedule a consultation.
