Spine Specialist in Texas
Spondylolisthesis is graded from I to V based on vertebral slippage. While mild cases often improve with conservative care, surgery may be required for higher grades, neurological symptoms, or failed conservative management. Evaluation by a spine specialist and imaging (X-rays, MRI, CT) is essential for decision-making. Spondylolisthesis Treatment Institute provides advanced spine care in Texas, combining expert surgical skill with the latest technology. Spondylolisthesis Treatment Institute also delivers personalized care throughout your recovery. Contact Spondylolisthesis Treatment Institute’s office to schedule an appointment today!
What is Spondylolisthesis?
Spondylolisthesis is a condition where one vertebra slips forward over the one below it. This slippage can compress nerves, causing back pain, leg pain, or neurological symptoms. It most commonly affects the lower spine (lumbar region), especially between L4-L5 or L5-S1.
How is Spondylolisthesis Graded?
Grading for spondylolisthesis is performed using lateral spine X-rays, typically of the lumbar region. The grading is based on the percentage of forward slippage of the upper vertebra over the vertebra below it. The measurement is done by comparing how much of the top vertebra has slipped forward relative to the total length of the vertebral body beneath.
Grading System:
- Grade I: 0–25% slippage
- Grade II: 26–50%
- Grade III: 51–75%
- Grade IV: 76–100%
- Grade V (Spondyloptosis): >100% (complete slippage off the vertebra below)
Grading spondylolisthesis helps guide treatment decisions. Lower grades may be managed conservatively, while higher grades or symptomatic cases often require surgery to relieve pain, restore function, and prevent progression.
When is Surgery for Spondylolisthesis Needed?
Surgery for spondylolisthesis is generally considered when:
- Non-surgical treatments fail (e.g., physical therapy, medications, injections)
- Neurological symptoms such as numbness, weakness, or bladder/bowel dysfunction occur
- Persistent severe pain affects quality of life
- Progressive slippage is observed on imaging
- High-grade slips (Grade III or above) with instability are noted
What Happens After Grading Spondylolisthesis?
After spondylolisthesis grading, the next steps typically include:
- Treatment Planning: The grade helps determine whether the condition can be managed conservatively or requires surgery.
- Conservative Management (usually for Grade I–II):
- Physical therapy
- Pain medications
- Bracing or posture correction
- Activity modification
- Monitoring: Mild cases are periodically monitored with repeat imaging to track slippage or worsening symptoms.
- Surgical Evaluation (often for Grade III–V or worsening symptoms): If slippage is severe or there are neurological signs, a spine specialist may recommend surgery to stabilize the spine and decompress nerves. Common procedures include spinal decompression (laminectomy), which removes bone or tissue pressing on nerves, and spinal fusion, which permanently joins affected vertebrae to prevent further movement. In moderate to high-grade cases (Grade II–V), spinal fusion is often combined with instrumentation such as rods and screws to enhance stability. In some cases, reduction techniques are used to realign the slipped vertebra before fusion. Minimally invasive surgical approaches may also be employed to reduce recovery time and tissue damage.
