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Oct 05, 2023

Spondylolisthesis Grading: How to Diagnose and Treat Grades 1, 2, 3, 4 and 5

What grade of spondylolisthesis do i have.

Like many other conditions, spondylolisthesis can be measured using a grading system, where your spondylolisthesis grade is based on the degree of displacement of your vertebrae. Grades of spondylolisthesis influence what symptoms you might experience as well as what treatment you will likely receive.

Wondering what might be the cause of your spondylolisthesis? Read more about the causes and symptoms .

The grade of your condition is based on the distance from the posterior edge of the superior body of the vertebrae to the same edge of the inferior vertebral body. The ratings range from spondylolisthesis grade 1 to spondylolisthesis grade 5: grade 1 spondylolisthesis being least severe and grade 5 most severe. To diagnose this condition, your doctor will take X-rays in order to see if any of the bones in your vertebrae have slipped or are misaligned. They may order a CT scan or MRI to figure out how severe your slippage may be.

Do I Have Grade 1 Spondylolisthesis?

Grade I, or grade 1 spondylolisthesis is the least severe case. The degree of slippage for spondylolisthesis grade 1 ranges from 0%-25%. Grade 1 anterior spondylolisthesis usually occurs in the l4 on the l5 segment of the spine, which is connected, to your facet joints. Fortunately, spondylolisthesis conditions are typically not very severe, leaving grade 1 and grade 2 being the most frequent gradings.

Spondylolisthesis grade 1 treatment is typically using conservative methods since the slippage isn’t very severe. For starters, bed rest can help relieve your pain and take the extra stress off of your spine and back. In addition, try avoiding activities that may further your injury and slippage such as high contact sports.

Do I Have Grade 2 Spondylolisthesis?

Similar to grade 1, grade 2 is a low-grade spondylolisthesis. Grade ii spondylolisthesis degree of slippage is between 26% to 50%.

Spondylolisthesis grade 2 treatment is similar to grade 1, it starts with conservative methods such as resting, anti-inflammatory medications, and reducing the number of daily activities that may harm your back. Exercises and stretches for spondylolisthesis help strengthen the muscles surrounding your spine and is another great conservative treatment option.

Physical therapy works similarly. It helps to improve the strength and flexibility of your back and other parts of the core, which can reduce the amount of pressure the spine, endures. This ultimately relieves discomfort associated with grade 1 spondylolysis or spondylolisthesis grade 2 and helps slow additional slippage.

For those whose grade 2 spondylolisthesis condition doesn’t respond to such methods above or if you feel as though your condition is worsening, try bracing to help immobilize your spine. Such braces are usually used for individuals with 50% slippage or less. 

Do I Have Grade 3 Spondylolisthesis?

Grade 3 spondylolisthesis tends to be on the more serious side of the spectrum. Grade iii spondylolisthesis slippage is between 51% to 75%.

Grade 3 spondylolisthesis treatment typically involves the same conservative methods mentioned above, but if your condition persists or get worse, surgery for spondylolisthesis is an option for this grade.

Before considering surgery for spondylolisthesis grade 3, it’s important to take in consideration:

• If your pain from spondylolisthesis has lasted for 6-12 months and has not improved
• If your slip is progressing
• If you are having trouble walking, sleeping, etc.
• If you are an obese individual, you may have a higher risk for surgery complications

Do I Have Grade 4 Spondylolisthesis?

Grade 4 spondylolisthesis goes along with grade 3 but is more severe. Spondylolisthesis grade 4 slippage is between 76% to 100%.

Treatment options for spondylolisthesis more commonly involve isthmic and degenerative surgery . Surgery for spondylolisthesis can help the instability in your spine as well as relieve compression that is being placed on your nerve roots.

Do I Have Grade 5 Spondylolisthesis or Spondyloptosis?

For grade 5 spondylolisthesis, your vertebra has completely fallen off the next vertebra. When the vertebra slides completely off the vertebra that is supposed to be beneath it, this is known as spondyloptosis.

For this rare condition, surgery is the only way to completely fix or heal spondylolisthesis of grade 5. Your surgeon may perform a vertebrectomy, which is an alternative procedure to help align your vertebra.

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Spondylolisthesis: Definition, Causes, Symptoms, and Treatment

by Dave Harrison, MD • Last updated November 26, 2022

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What is Spondylolisthesis?

The spine is comprised of 33 bones, called vertebra , stacked on top of each other interspaced by discs . Spondylolisthesis is a condition where one vertebra slips forward or backwards relative to the vertebra below. More specifically, retrolisthesis is when the vertebra slips posteriorly or backwards, and anterolisthesis is when the vertebra slips anteriorly or forward.

Spondylosis vs Spondylolisthesis

Spondylosis and Spondylolisthesis are different conditions. They can be related but are not the same. Spondylosis refers to a fracture of a small bone, called the pars interarticularis, which connects the facet joint of the vertebra to the one below. This may lead to instability and ultimately slippage of the vertebra. Spondylolisthesis, on the other hand, refers to slippage of the vertebra in relation to the one below.

Types and Causes of Spondylolisthesis

There are several types of spondylolisthesis, often classified by their underlying cause:

Degenerative Spondylolisthesis

Degenerative spondylolisthesis is the most common cause, and is due to general wear and tear on the spine. Overtime, the bones and ligaments which hold the spine together may become weak and unstable.

Isthmic Spondylolisthesis

Isthmic spondylolisthesis is the result of another condition, called “ spondylosis “. Spondylosis refers to a fracture of a small bone, called the pars interarticularis, which connects the facet joint of the vertebra to the one below. If this interconnecting bone is broken, it can lead to slippage of the vertebra. This can sometimes occur during childhood or adolsence but go unnoticed until adulthood when degenerative changes cause worsening slippage.

Congenital Spondylolisthesis

Congenital spondylolisthesis occurs when the bones do not form correctly during fetal development

Traumatic Spondylolisthesis

Traumatic spondylolisthesis is the result of an injury such as a motor vehicle crash

Pathologic Spondyloslisthesis

Pathologic spondylolisthesis is when other disorders weaken the points of attachment in the spine. This includes osteoporosis, tumors, or infection that affect the bones and ligaments causing them to slip.

Iatrogenic Spondylolisthesis

Iatrogenic spondylolisthesis is the result of a prior surgery. Some operations of the spine, such as a laminectomy, may lead to instability. This can cause the vertebra to slip post operatively.

Spondylolisthesis Grades

Spondylolisthesis is classified based on the degree of slippage relative to the vertebra below

• Grade 1 : 1 – 25 % forward slip. This degree of slippage is usually asymptomatic.
• Grade 2: 26 – 50 % forward slip. May cause mild symptoms such as stiffness and pain in your lower back after physical activity, but it’s not severe enough to affect your everyday activities.
• Grade 3 : 51 – 75 % forward slip. May cause moderate symptoms such as pain after physical activity or sitting for long periods.
• Grade 4: 76 – 99% forward slip. May cause moderate to severe symptoms.
• Grade 5: Is when the vertebra has slipped completely of the spinal column. This is a severe condition known as “spondyloptysis”.

Symptoms of Spondylolisthesis

Spondylolisthesis can cause compression of spinal nerves and in severe cases, the spinal cord. The symptoms will depend on which vertebra is affected.

Cervical Spondylolisthesis (neck)

• Arm numbness or tingling
• Arm weakness

Lumbar Spondylolisthesis (low back)

• Buttock pain
• Leg numbness or tingling
• Leg weakness

Diagnosing Spondylolisthesis

Your doctor may order imaging tests to confirm the diagnosis and determine the severity of your spondylolisthesis. The most common imaging tests used include:

• X-rays : X-rays can show the alignment of the vertebrae and any signs of slippage.
• CT scan: A CT scan can provide detailed images of the bones and soft tissues in your back, allowing your doctor to see any damage or abnormalities.
• MRI: An MRI can show the spinal cord and nerves, as well as any herniated discs or other soft tissue abnormalities.

Treatments for Spondylolisthesis

Medications.

For those experiencing pain, oral medications are first line treatments. This includes non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, acetaminophen, or in severe cases opioids or muscle relaxants (with extreme caution). Topical medications such as lidocaine patches are also sometimes used.

Physical Therapy

Physical therapy can help improve mobility and strengthen muscles around your spine to stabilize your neck and lower back. You may also receive stretching exercises to improve flexibility and balance exercises to improve coordination.

Surgery is reserved for severe cases of spondylolisthesis in which there is a high degree of instability and symptoms of nerve compression.

In these cases a spinal fusion may be necessary. This surgery joins two or more vertebra together using rods and screws, in order to improve stability.

Reference s

• Alfieri A, Gazzeri R, Prell J, Röllinghoff M. The current management of lumbar spondylolisthesis. J Neurosurg Sci. 2013 Jun;57(2):103-13. PMID: 23676859.
• Stillerman CB, Schneider JH, Gruen JP. Evaluation and management of spondylolysis and spondylolisthesis. Clin Neurosurg. 1993;40:384-415. PMID: 8111991.

About the Author

Dave Harrison, MD

Dr. Harrison is a board certified Emergency Physician with a part time appointment at San Francisco General Medical Center and is an Assistant Clinical Professor-Volunteer at the UCSF School of Medicine. Dr. Harrison attended medical school at Tufts University and completed his Emergency Medicine residency at the University of Southern California. Dr. Harrison manages the editorial process for SpineInfo.com.

Spondylolisthesis

• Diagnosis |
• Treatment |

Spondylolisthesis is partial displacement of a bone in the lower back.

Injuries or a degenerative condition can cause this disorder.

Pain is felt in the low back and may travel down one or both legs.

The diagnosis is based on the results of imaging tests.

Treatment includes measures to relieve pain.

The spine (spinal column) consists of back bones (vertebrae) stacked one on top of another. In lumbar spondylolisthesis, a vertebrae in the lower back slips forward. This disorder usually occurs during adolescence or young adulthood (often in athletes). It is usually caused by a birth defect or an injury that causes fractures (breaks) in a part of the vertebra. If both sides of the vertebra are involved, the vertebra can then slip forward over the one below it. Spondylolisthesis can also occur in older adults, mainly as the result of degeneration of the discs between the vertebrae or osteoarthritis . People who develop spondylolisthesis as adults are at risk of developing lumbar spinal stenosis .

Symptoms of Spondylolisthesis

Mild to moderate spondylolisthesis may cause little or no pain, particularly in young people.

When pain occurs in adolescents, it is felt on only one side of the spine and may travel down a leg. The pain may accompany a fracture.

When pain occurs in adults, it is felt over a specific part of the spine and travels down both legs. In these cases, the pain results from a degenerative condition.

Pain is worsened by standing or leaning back. It can be accompanied by numbness, weakness, or both in the legs.

Diagnosis of Spondylolisthesis

Imaging tests

Doctors base the diagnosis of spondylolisthesis on imaging tests, usually x-rays taken of the lower spine.

Other imaging tests, such as magnetic resonance imaging (MRI) or sometimes computed tomography (CT), may be done.

Treatment of Spondylolisthesis

Measures to relieve pain and stabilize the spine

One to two days of bed rest may provide pain relief for people with spondylolisthesis. Longer bed rest weakens the core muscles and increases stiffness, thus worsening back pain and prolonging recovery. Sleeping in a comfortable position on a medium mattress is recommended. People who sleep on their back can place a pillow under their knees. People who sleep on their side should use a pillow to support their head in a neutral position (not tilted down toward the bed or up toward the ceiling). They should place another pillow between their knees with their hips and knees bent slightly if that relieves their back pain. People can continue to sleep on their stomach if they are comfortable doing so.

Applying cold (such as ice packs) or heat

Physical therapy and exercises to strengthen and stretch the muscles in the abdomen, buttocks, and back (the core muscles) may help. (See also Low Back Pain: Prevention .)

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