Chapter 53

Spondylolisthesis Grades

Nick G. Lasanianos, George K. Triantafyllopoulos,

and Spiros G. Pneumaticos

Description

The Meyerding Grading System for classifying spondylolisthesis is a relatively ease

system in which slips are graded on the basis of the percentage that one vertebral
body has slipped forward over the vertebral body below [1] (Fig. 53.1).
Grade I: 1–24 % of the vertebral body has slipped forward over the body below
Grade II: 25–49 % slip
Grade III: 50–74 % slip
Grade IV: 75–99 % slip
Grade V: Complete or 100 % slip is termed Spondyloptosis

N.G. Lasanianos, MD, PhD, MSc

Academic Department of Trauma and Orthopaedics,
School of Medicine, University of Leeds, Leeds, UK
e-mail: nikolaos@lasanianos.gr
G.K. Triantafyllopoulos, MD, PhD
3rd Academic Department of Trauma and Orthopaedics,
KAT Hospital, Athens, Greece
e-mail: yotriad@hotmail.com
S.G. Pneumaticos, MD, PhD (*)
3rd Academic Department of Trauma and Orthopaedics,
School of Medicine, University of Athens, Athens, Greece
e-mail: irosp@bcm.edu

© Springer-Verlag London 2015 239

N.G. Lasanianos et al. (eds.), Trauma and Orthopaedic Classifications:
A Comprehensive Overview, DOI 10.1007/978-1-4471-6572-9_53
240 N.G. Lasanianos et al.

Fig. 53.1 The five grades of the Meyerding system: grade I slippage <24 % of the vertebral body;
grade II 25–49 %; grade III 50–74 %; grade IV 75–99 %; grade V complete 100 % - Spondyloptosis

Treatment Strategy

Most degenerative spondylolisthesis cases involve Grade I or Grade II. There is not
a precise relation between grade of spondylolisthesis and treatment, however, as a
general guideline, the more severe slips (especially Grades III and above) are most
likely to require surgical intervention.

Non-operative Treatment

For most cases of degenerative spondylolisthesis (especially Grades I and II), treat-
ment consists of temporary bed rest, restriction of the activities that caused the onset
of symptoms, pain/anti-inflammatory medications, steroid-anaesthetic injections,
physical therapy and/or spinal bracing. Degenerative spondylolisthesis can be pro-
gressive – meaning the damage will continue to get worse as time goes on. In addi-
tion, degenerative spondylolisthesis can cause stenosis, a narrowing of the spinal
canal and spinal cord compression. If the stenosis is severe, and all non-operative
treatments have failed, surgery may be necessary.

Surgical Treatment

Surgery is rarely needed unless the case is severe (usually Grade III or above).
Grade III and IV are usually accompanied by symptomatology which also serves as
an indication for surgery. This is:
53 Spondylolisthesis Grades 241

• Intensive suffering from hard pain despite adequate non-operative therapy and
adaptation of living and working conditions
• Occurrence of neurological defects
• Worsening spondylolisthesis
Objectives of surgical therapy are:
• Stabilization of the mobile segment (spondylodesis) with restoration of physio-
logical intervertebral space height
• Elimination of neurological symptoms as needed (by means of repositioning
and/or decompression)
• Pain reduction
• Improvement of spinal column statics.
Laminectomy and fusion is the most common procedure done. The spinal canal
is widened by removing or trimming the laminae (roof) of the vertebrae relieving
pressure on the spinal cord. Fusion to support the unstable spine is also necessitated
and may be accomplished by various implants (screws/interbody cages/graft).

Spondylolisthesis: evidence according to Meyerding grading system

Cochrane
Classification Meta-analysis Systematic review library
Grade I Nonoperative treatment Operative treatment is not Lack of
in children and young superior to non-operative evidence
adults [1] measures [2, 3]
Surgery should be considered
after failure of nonoperative
treatment [4]
Limited evidence to support direct
repair vs fusion [5]
Grade II Lack of evidence Operative treatment is not Lack of
superior to non-operative evidence
measures [2, 3]
Surgery should be considered
after failure of non-operative
treatment [4]
Limited evidence to support direct
repair vs fusion [5]
Grade III Lack of evidence Surgery should be considered Lack of
after failure of nonoperative evidence
treatment [4]
Limited evidence to support
reduction and fusion vs in situ
fusion [6]
242 N.G. Lasanianos et al.

Spondylolisthesis: evidence according to Meyerding grading system

Cochrane
Classification Meta-analysis Systematic review library
Grade IV Lack of evidence Surgery should be considered Lack of
after failure of nonoperative evidence
treatment [4].
Limited evidence to support
reduction and fusion vs in situ
fusion [6]
Grade V Lack of evidence Surgery should be considered Lack of
after failure of nonoperative evidence
treatment [4]
Limited evidence to support
reduction and fusion vs in situ
fusion [6]

References

1. Meyerding HW. Spondylolisthesis; surgical fusion of lumbosacral portion of spinal column

and interarticular facets; use of autogenous bone grafts for relief of disabling backache. J Int
Coll Surg. 1956;26(5 Part 1):566–91.
2. Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis:
a systematic review of the literature. Eur Spine J. 2006;15(4):391–402.
3. Kwon BK, Hilibrand AS, Malloy K, Savas PE, Silva MT, Albert TJ, Vaccaro AR. A critical
analysis of the literature regarding surgical approach and outcome for adult low-grade isthmic
spondylolisthesis. J Spinal Disord Tech. 2005;18(Suppl):S30–40.
4. Wood KB, Fritzell P, Dettori JR, Hashimoto R, Lund T, Shaffrey C. Effectiveness of spinal
fusion versus structured rehabilitation in chronic low back pain patients with and without isth-
mic spondylolisthesis: a systematic review. Spine (Phila Pa 1976). 2011;36(21 Suppl):S110–9.
5. Westacott DJ, Cooke SJ. Functional outcome following direct repair or intervertebral fusion for
adolescent spondylolysis: a systematic review. J Pediatr Orthop B. 2012;21(6):596–601.
6. Transfeldt EE, Mehbod AA. Evidence-based medicine analysis of isthmic spondylolisthesis
treatment including reduction versus fusion in situ for high-grade slips. Spine (Phila Pa 1976).
2007;32(19 Suppl):S126–9.