The Meyerding System –Determining the Severity of Spondylolisthesis
Spondylolisthesis can occur at varying levels of severity,and the severity of this condition is typically measuredby the degree to which a vertebra has slipped out ofplace. Classifying the degree of vertebral slippage isextremely important when forming a treatment plan.The standard system for “grading” spondylolisthesiswas created by a man named Henry WilliamMeyerding, an orthopedic surgeon who joined theMayo Clinic in 1911.
Meyerding ClassificationMeyerding classified vertebral slippage of: • 0-25 percent – Grade 1 • 26-50 percent – Grade 2 • 51-75 percent – Grade 3 • 76-99 percent – Grade 4Although not technically part of theMeyerding system, specialists refer toGrade 5 spondylolisthesis when there is100 percent slippage, meaning the vertebra slips entirely off the vertebra beneath it.
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 apatient will need surgery. Instances of spondylolisthesis that are classified as Grades 1 and 2 and arecausing nerve compression can usually be treated with conservative techniques. While each patient’streatment plan will be at the discretion of his or her individual doctor, common approaches to painrelief 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.
Treatment Based on SymptomsOne main goal of any spondylolisthesis treatment is to relieve a patient’s pain. In manyinstances, patients with Grade 1 or Grade 2 vertebral slippage may not evenexperience symptoms and, therefore, will not require any type of treatment. However,if you do have symptomatic spondylolisthesis, you should know that finding aneffective treatment plan will involve trial and error.Be patient as you try a wide range oftreatments, and only consider surgery ifnon-operative techniques have proven ineffectiveover a period of three months or longer.