1. The Meyerding System –
Determining the Severity of
Spondylolisthesis

2. Spondylolisthesis can occur at varying levels of severity,
and the severity of this condition is typically measured
by the degree to which a vertebra has slipped out of
place. Classifying the degree of vertebral slippage is
extremely important when forming a treatment plan.
The standard system for “grading” spondylolisthesis
was created by a man named Henry William
Meyerding, an orthopedic surgeon who joined the
Mayo Clinic in 1911.

3. Meyerding Classification
Meyerding classified vertebral slippage of:
• 0-25 percent – Grade 1
• 26-50 percent – Grade 2
• 51-75 percent – Grade 3
• 76-99 percent – Grade 4
Although not technically part of the
Meyerding system, specialists refer to
Grade 5 spondylolisthesis when there is
100 percent slippage, meaning the vertebra slips entirely off the vertebra beneath it.

4. How Does the Meyerding Grade Affect
Spondylolisthesis Treatment Options?
In general, the more severe the vertebral slippage (Grades 3 and 4), the higher the likelihood is that a
patient will need surgery. Instances of spondylolisthesis that are classified as Grades 1 and 2 and are
causing nerve compression can usually be treated with conservative techniques. While each patient’s
treatment plan will be at the discretion of his or her individual doctor, common approaches to pain
relief may include:
• Grade 1 – Over-the-counter pain medication (such as aspirin, ibuprofen, or naproxen), hot/cold
compresses, periods of rest, behavior modification, gentle stretching, low-impact exercise, physical
therapy, and minimally invasive surgical procedures treat the compression of a nerve root or the
spinal cord.
• Grade 2 – Prescription anti-inflammatory drugs such as oral steroids or muscle relaxants, bracing,
corticosteroid injections, TENS (transcutaneous electrical nerve stimulation), and the possibility of a
minimally invasive surgical procedure to treat spinal nerve compression.
• Grade 3 – Surgery in the form of a laminotomy with spinal fusion, though surgery should not
become a consideration until a combination of the above conservative treatments has been
attempted. Some patients with Grade 3 slippage may still be candidates for minimally invasive
procedures.
• Grade 4 – Surgery in the form of a posterior or anterior interbody fusion is usually required.
Minimally invasive procedures are generally not effective for this degree of slippage.

5. Treatment Based on Symptoms
One main goal of any spondylolisthesis treatment is to relieve a patient’s pain. In many
instances, patients with Grade 1 or Grade 2 vertebral slippage may not even
experience symptoms and, therefore, will not require any type of treatment. However,
if you do have symptomatic spondylolisthesis, you should know that finding an
effective treatment plan will involve trial and error.
Be patient as you try a wide range of
treatments, and only consider surgery if
non-operative techniques have proven ineffective
over a period of three months or longer.