Classification according to Meyerding

The Meyerding classification of severity is commonly used, which is based on the extent of the angle of tilt of the two vertebrae in relation to each other. This requires a lateral X-ray image of the spine, which is part of the standard diagnostic procedure for spondylolisthesis. The classification according to Meyerding distinguishes 4 degrees of severity of spondylolisthesis.

There are sometimes different descriptions for assessing the classification. The lower vertebral body of the two adjacent vertebrae is divided into 4 parts. If the upper vertebra is displaced by less than 1⁄4 in relation to the lower vertebra, this is referred to as Meyerding grade I.

If the gliding process is more advanced, namely by up to 50%, it is referred to as a Meyerding Grade II. At an offset of 50 to 75%, it is a Meyerding Grade III. An offset of more than 75% defines a Meyerding Grade IV.

According to some authors there is also a Grade V according to Meyerding. This is a so-called spondyloptosis, in which the two vertebrae no longer have any contact with each other. In the true sense, grade V does not represent a spondylolisthesis.

A grade I spondylolisthesis according to Meyerding is the most morphologically pronounced form of spondylolisthesis. The offset of the vertebrae to each other is less than 25%, which means that the vertebrae are displaced to each other by less than 1⁄4 of the width of the lower vertebral body. This can be seen in the lateral x-ray image.

The degree of spondylolisthesis can, but does not necessarily correlate with the extent of the symptoms. Spondylolisthesis is asymptomatic in 90% of cases anyway. In combination with other diseases such as spinal canal stenosis, however, it can cause symptoms.

A therapy is not necessarily necessary. Further spondylolisthesis can be prevented by physiotherapy and a good strengthening of the back muscles. A grade II spondylolisthesis according to Meyerding is characterized by an offset of the two vertebrae between 25 and 50% to each other.

The displacement of the slipped vertebrae is determined on the basis of a lateral x-ray image and provides information about the extent of spondylolisthesis. However, the symptoms do not capture the graduation. In more than 90% of cases, no symptoms at all.

For this reason, a conservative therapy in the form of physiotherapy and follow-up observation is sufficient for grade 2 according to Meyerding.Triggering sports like gymnastics or weight lifting should be avoided. Monitoring is important because young patients are more likely to have a progressive course, i.e. rapid progression of spondylolisthesis, than older patients. In the latter, spondylolisthesis usually occurs in the context of degenerative changes in the spine.

If the vertebrae are offset from each other by 50 to 75%, this is referred to as grade III spondylolisthesis according to Meyerding. This is a high-grade spondylolisthesis that can lead to spinal instability. In this case, surgical therapy can be considered to restore the stability of the spine. With a grade III according to Meyerding, a symptomatology is likely but not obligatory.