Spondylolisthesis Grades

spondylolisthesis grades

Perhaps you have been told that you have a grade 1 spondylolisthesis. Do you know what this really means or why you have that particular grade of spondylolisthesis?

Do you know what seperates a grade 1 spondylolisthesis from a grade 2 spondylolisthesis? If not, do not worry.

This article is going to help clarify spondylolisthesis grades in a simple manner so you can understand them.

First, let’s discuss the grading system and how it works.

One of the most common and widely used grading scales is called the Meyerding Grading System.  This system was created by Henry William Meyerding and is most often used when describing the severity a spondylolisthesis. This grading system uses percentages to label individuals into grading catergories. We will explain this more in a minute.

But first, to understand the grading system you need to fully understand what a spondylolisthesis is.  These following articles will do just that:

Now that you have a basic understanding of your spondylolisthesis or spondylolysis we can move on to the grading system.

When a spondylolisthesis is present, the fracture that is usually created from repetitive stress or degeneration at a rate faster than the body’s ability to repair, can slide or slip over  another vertebrae (and in some cases a fracture may not be present for their to be slippage or a displacement – often times this may be from degenerative changes).

This slippage or displacement can cause several problems. One, a great deal of inflammation can arise. Two, a variety of painful sensations created from nerve pain to irritated tissues usually follow a slip.  And third, your body may compensate how you move to adjust to the pain.

Your initial doctor’s visit will most likely involve a series of X-rays.  These X-rays will be taken from a few different angles.  The lateral (side) X-rays will help to provide your doctor with a view of your vertebral column.  This view shows the vertebrae’s positioning in relation to each other.

spondylolisthesis displacement - jpeg

Lateral (side) view of the lower back with a fracture and slippage.

This view will also give the doctor a pretty good estimate of what grade of spondylolisthesis you have.  The doctor looks at the posterior portion of the superior vertebrae in relation to the posterior portion of the inferior vertebrae to determine the amount of slippage as a percentage.

Let’s explain this a little more because this is where people often get confused……..

For example, using the same photo as above you notice the fracture of a section called the pars interarticularis.

Explanation of Spondylolisthesis Grading

You can then tell that one vertebra has slid over the top of the vertebrae below it.

The doctor would then look at the back part (posterior) of the top (superior) vertebrae and compare it to the back part of the bottom (inferior) vertebrae.

The amount of space that is between these two posterior portions of the vertebrae is measured as a percentage. The doctor may then use the following Meyerding grading scale to determine the severity of the slippage.

Grade 1 Spondy = 0-25% slippage
Grade 2 Spondy = 26-50% slippage
Grade 3 Spondy = 51-75% slippage
Grade 4 Spondy = 75% and greater.

Therefore, if you went to the doctor and discovered that you had 20% of slippage in one vertebra when compared with another you would be classified as having a Grade 1 spondylolisthesis.

According to statistics, grades 1 and 2 are the most common types of spondylolisthesis. But it is still impossible to tell which grade you have without the help of an X-ray machine and your doctor’s expertise.

Many people think that since their pain is so bad they have the highest grade. The problem with that is everyone handles pain differently.

The specific tissues under stress may also significantly affect your symptoms. Therefore, what might feel like a grade 3 spondy might really be a grade 1 spondy or vice versa.

Hopefully this gives you a true understanding of what the grading system entails. Make sure to ask your physician about your grade. Knowing your grade will give you a piece of knowledge that can really help in your recovery process.

What grade of spondylolisthesis do you have?

Tell us a little of your story by commenting below. The more conversations we have, the better the chances are of helping someone else.

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Leave A Reply (14 comments so far)


  1. Tomas Bielik
    4 years ago

    Hi Spondy Experts,

    thank you for your help and information. I am 45 years old and I’ve been diagnosed with spondylolisthesis grade 1-2 at L5/S1 and also bilateral hip FAI (right equals left) about 6 months ago.
    The actual injury happened 10 years ago at a construction site and I left it due to my circumstances untreated. My chiropractor has fixed me within few sessions and I’ve been working manually and doing sports ever since.
    At the end of 2012 I started having sciatic nerve and lower back pain on few occasions so I visited a top specialist here in Sydney who made the correct diagnosis and also recommended stretches and exercises. I’ve changed my demolition job since then and I don’t work that hard anymore. Yet I love to do my dragonboating sport (competing internationally), soft sand running, swimming and especially my gym workouts which I’m slowly transferring into CrossFit routines with a lot of squats and also deadlifts involved. I own a foam roller and visit a massage therapist every now and then and watching my correct movement throughout the day.

    I really feel that I’m able to increase my workouts and get fitter. My wife and I have a little baby boy now and want to stay healthy and in a decent shape for the next 20-30 years.

    I just thought I’ll share my story with you. If you have any recommendations about what I should or shouldn’t do or would like more information about my condition, please contact me.

    Thank you again for your useful information,

    Tomas


    • Spondy
      4 years ago

      Hi Tomas,

      What a great story and thank you so much for sharing it with us and everyone else. It really goes to show that with proper movement and exercise you are able to accomplish some great things. It sounds like you are really active which is great and it also sounds like you got in touch with some very knowledgeable people to help you out. I would continue doing what you love and enjoying life. Crossfit is a very successful program and is really growing. My only piece of advice is to make sure you maintain quality movement (your stretches and mobility work) while you continue to ramp up the intensity. Crossfit can be very successful, but they get the results they do by high intensity/high volume work. Which isn’t bad, but the movements have to be performed correctly. So when you have very high volume workouts always be cautious of positioning and movement of your body. As your body gets tired and breaks down it is most susceptible to injury and compensations. It sounds like you are already on top of that which is awesome! Thank you again for sharing your great story,stay strong, and best of luck!


  2. Raelene
    3 years ago

    Hello all,
    Thanks for all the awesome info. I am 38 yrs old and was diagnosed last month with spondylosis and spondylothesis L5-S1 along with significant disc narrowing ofL5-S1. I have always played competitive soccer but was sidelined earlier this year with low back and hip pain. My chiropractor was the one who suggested xrays after a massage left me in agony and struggling to walk. I am so thankful for the explanation, but was a bit overwhelmed at first. I am back playing again thanks to core strengthening and a functional movement assessment. This led to lots of hip flexor stretching, IMS , myofascial release and gluteus medius strengthening. I know I need to stay on top of things and actually find being sedentary worse! I am appreciative of this blog and site.
    Thanks!!
    Raelene


    • Spondy
      3 years ago

      Hi Rae. I hope the information has proven to be helpful. I understand how everything can be overwhelming. There is so much to learn about this condition and everything that goes along with it. As you continue to learn more about the condition along with your personal physical weaknesses you will continue to improve. I also agree with you on the sedentary comment. I know for a fact that being sedentary is the WORST for my spondy. It leads to stiffness, pain and inflammation. I am glad you are back to playing again and also glad the functional movement assessment has helped you find some weaknesses to work on. Best of luck and keep us updated on your progress!


  3. Gerald Everitt
    3 years ago

    First diagnosed at an army physical in 1972. Later learned that it was classed as a stage 2 spondylolisthesis! Hurt back playing football as a kid but never knew what happened! Guessing there was a small break that allowed 5th lumbar vertebrate to slip forward approximately 50%! Have noticed some disc degeneration at L5.

    Have had issues off and on over the years. Chiropractic care has proved beneficial during periodic flare ups! Currently age 61 and pain free at the present time. I am experiencing some hip stiffness and limited range of motion that may be a result of this condition and am looking for a possible confirmation and possible recommendations for improvement in range of motion in my hips!

    Please advise!

    Thanks,
    Gerald Everitt


    • SpondyInfo
      3 years ago

      Hi Gerald. Thanks for sharing your story. It is great that you are currently pain free at the moment. The important thing is that you stay pro-active and continue to work to keep your pain at bay. Starting at the hips is a great start especially if you have issues with tightness/ROM . My suggestion Gerald is to begin with a full body evaluation that looks at everything. Not just your hips. Your hips may be tight for a reason and simply stretching them may not find the culprit behind WHY they are getting tight. In THIS BLOG post I discuss why your overall movement is important and how you can improve your current movement levels. I encourage you to give it a read Gerald and don’t hesitate to get back to me with further questions. Thanks and best of luck!


  4. Carol
    2 years ago

    First of all, Justin, I want to thank you for your kindness and compassion in providing us with this invaluable info. I was just diagnosed with L4 grade 4. I had no idea whatsoever I had such a devastating condition. I go to a chiropractor from time to time when I had some back issues and was helped so I didn’t have to go again for a very long time. I first noticed the slight lump in my back as young adult, but it never was addressed by a doctor or chiropractor. It really started to act up three years ago and from my symptoms (discomfort in my inner left thigh, groin and left knee, my chiropractor thought it was a pinched nerve, which it probably was from what I’ve learned about this horrid ailment. He fixed my up and it didn’t act up until the following year. He fixed me up again. This past March it started and this time he couldn’t help me. He sent me for x-rays. Them the gloomy diagnosis! I’m a very young 65. I go to Curves, do a lot of yard work, stack wood, etc. My symptoms are puzzling to my chiropractor, as my back does not bother me, I have no sciatica and no numbness. I had several bad falls on my back on the ice as a youngster, hence spondy! I’m sorry for going on and on but I’m beside myself with worry. I don’t want that invasive surgery. Bottom line: Do you think physical therapy will help me?
    Thank you,
    Carol


    • SpondyInfo
      2 years ago

      Hi Carol. It sounds like you are very active which is a great thing! Whenever someone is active and has a spondy poor movement can often play a huge role in producing compensations and stress to the body. Especially in areas that are vulnerable such as the back. I really cannot answer your question accurately – as it is impossible to know the exact extent of your condition along with various other factors such as your movement, past injury history, etc – but CORRECT physical therapy is always a great start. I would recommend looking for a board certified physical therapist who is certified in the SFMA screening method. This would be a great start and you can learn more about it here:http://spondyinfo.com/how-poor-movement-can-affect-your-spondy-and-how-to-fix-it/
      I hope this helps Carol and best of luck!


  5. William Sidenfaden
    8 months ago

    Hi Spondy experts,
    Per an MRI I have spondylolisthesis at L4/5 per the radiologist and surgeon. The details in short:
    At L4-L5 severe facet arthritis is associated with 5 mm anterolisthesis of L4 on L5. Stenous throughout. Mild compression of the right L5 nerve root in the right lateral recess noted. Without going into further details regarding my story, my Key Question for now is , “What Stage (Grade 1 to 4)of Spondy am I dealing with at a 5mm slippage. It was at 4mm slippage 5 to 10 years ago.
    Thanks for any insight you may have for me.
    Bill S.


    • SpondyInfo
      8 months ago

      Hi William. Measured from front to back, the adult L4 and L5 vertebra are roughly 50 mm (a bit less for females, a bit more for males). Grading of spondylolisthesis is typically given in percentages of the size of the vertebra because there is so much variation in size from adolescent to adult, male to female, and even within one male to another (ex: comparing a 5’2″ male to a 6’8″ male), and the L3 vertebra is smaller than the L5 vertebra. That’s why the measured displacement in mm doesn’t necessarily confirm if it’s a grade 1 or grade 2 spondy because you need to know the size of the person’s vertebra.

      Since a grade 1 is 0-25% displacement of the vertebra, you can get a very general sense of the displacement in mm using the average sizes of vertebrae. So if the average adult has a L4 vertebra measuring 50 mm from front to back, and 25% of that is 12.5mm, then roughly 12.5mm of displacement or less would be given a label of grade 1.

      A 4-5 mm displacement for an adult is solidly a grade 1. A change of 1mm over the years is not likely to be a statistically significant change.

      It’s important to remember that the spine is part of a system, so there are many reasons why pain can be present even if a spondy is present (especially in the presence of “severe facet arthritis”). Plus, the MRI’s, CT’s, and X-ray’s are only part of the picture…what is the movement quality like? How is the system trying to compensate and what is it compensating for? A change to the movement system can make a nasty looking MRI a lot less significant.

      I hope that answers your question!


  6. Arun
    5 months ago

    Hi folks,

    i’m just shy of 30 and have been diagnosed with a grade 2 spondy at L5. I experience frequent sciatic pain (which is what got me to see a physiatrist and chiropractor), but for the most part, i haven’t let it get in the way of my squats, lunges, deadlifts, etc., playing squash, or doing yoga. I have always been pretty good in terms of watching my movement, and now I am extra vigilant. The hardest part is working a desk job and reminding myself to use the standing desk as much as possible.

    While I am optimistic, I can’t help but worry about the progression and what might be in store for me in 5-10-20 years from now. I’ve got some sever disc degradation at L5-S1, and I worry about a future of osteoarthritis, spinal stenosis, sciatic pain, and god forbid any serious weakness or incontinence.

    I guess I’m just looking for some reassurances that I can continue to be active with become unfit, bed-ridden, or worse.


    • SpondyInfo
      5 months ago

      Hi Arun. Welcome to the site!

      I know it is hard and easier said than done, but try your best not to worry about might what be. There are many spondy patients out there who live long lives with pain that is manageable and controllable with proper diet, lifestyle and exercise/stretching. Besides, who knows, 30 years from know as fast as technology and medicine are advancing they may have a simple cure or remedy for issues associated with spondy’s. The only thing you can do is to put yourself in the best position possible to control your spondy. Worrying about what might be only leads to stress, inflammation and maybe even more pain. Try your best to focus on staying healthy, active and on top of your personal weaknesses (movement related issues). This will put you in the best position possible to control your pain and live a long prosperous life. I hope this helps and best of luck!

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