Grade 2 Spondylolisthesis

Spondylolisthesis occurs when one of the bones of the spine, called vertebrae, slips out of its usual position and settles on the bone beneath it. This can set off a chain reaction in the surrounding tissues, causing back pain, stiffness, and, in some cases, neurological symptoms. Grade 2 spondylolisthesis involves a 25 to 50% slippage in the affected vertebra, and it’s a relatively common form of spondylolisthesis.

In this article, we’ll review grade 2 spondylolisthesis in detail, helping you better understand the condition and available treatment options. 

Understanding Grade 2 Spondylolisthesis: Diagnosis and Classification

Physicians may use the Wiltse and Meyerding classification systems to diagnose and classify grade 2 spondylolisthesis. 

Wiltse Classification System

The Wiltse classification system of spondylolisthesis is used to identify the condition’s etiology, or cause. This may help guide treatment and get to the root of the condition. Here are the categories:

  • Congenital/Dysplastic: Caused by genetic abnormalities in the spinal structure
  • Isthmic: Caused by a defect in the pars interarticularis, the bony bridge that links the upper and lower facet joints in the spine
  • Degenerative: Caused by spinal wear and tear
  • Traumatic: Caused by an acute fracture in the pars interarticularis
  • Pathologic: Caused by an underlying bone disease that weakens the spinal structures, like osteoporosis, spinal tumors, infections, or metabolic bone disorders
  • Post-surgical: Caused by spinal destabilization after surgery

Isthmic and degenerative are the most common types of grade 2 spondylolisthesis. Isthmic spondylolisthesis is particularly common in teen athletes, as they can develop pars interarticularis stress fractures from overuse. 

Meyerding Classification System

The Meyerding classification system of spondylolisthesis is used to specify the degree of vertebral slippage. It includes the following grades:

  • Grade I: 0 to 25% slippage
  • Grade II: 25 to 50% slippage
  • Grade III: 50 to 75% slippage
  • Grade IV: 75 to 100% slippage
  • Grade V: Over 100% slippage, or spondyloptosis 

Using the Meyerding system, grade 2 spondylolisthesis is considered low-grade. So, it can often be effectively managed with non-invasive treatments, including physical therapy, lifestyle adjustments, and pain medications. 

Symptoms of Grade 2 Spondylolisthesis

The most common symptoms of grade 2 spondylolisthesis are lower back pain, stiffness, and muscle tension. If the slipped vertebra compresses a nearby nerve, symptoms may also include radiating pain, weakness, numbness, and tingling. 

  • Lower back pain from grade 2 spondylolisthesis is often localized over the area with the slippage. The pain may worsen with certain activities, like standing and walking for prolonged periods or bending the spine backward. 
  • Muscle tension from spondylolisthesis often occurs in the lower back and hamstrings. This occurs because the slipped vertebra alters how you stand and walk, causing the back and leg muscles to work differently. Over time, the increased strain on the hamstring muscles can lead to tension. 
  • Neurological symptoms like weakness, numbness, and tingling that radiate into the legs result from spinal nerve compression. In some cases of grade 2 spondylolisthesis, the slipped vertebra doesn’t impinge on nearby nerves, so you won’t experience these symptoms. 

Non-Surgical Approaches to the Treatment of Grade 2 Spondylolisthesis

Non-surgical approaches to the treatment of grade 2 spondylolisthesis include physical therapy, back bracing, lifestyle adjustments, and medications. 

Physical Therapy

Physical therapy for grade 2 spondylolisthesis focuses on improving muscle strength, flexibility, and overall bodily balance. Through targeted exercises and stretches, your PT will aim to reduce stress on the spine and correct movement patterns that are worsening your symptoms. 

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Back Bracing

Wearing a back brace can help calm spondylolisthesis symptoms by keeping the spine stable and inhibiting motions that could exacerbate your pain. The brace gently compresses the torso, which alleviates impact from the spine and may even prevent muscle spasms. 

Lifestyle Adjustments

Healthy lifestyle changes can set your body up for a successful recovery from grade 2 spondylolisthesis. These adjustments include:

  • Reaching and maintaining a healthy weight
  • Eating meals and snacks that are rich in natural nutrients
  • Improving your posture, particularly while sitting at a desk for long stretches of time
  • Following a low-impact exercise routine
  • Adjusting your sleeping position to avoid straining the spine at night

Medications

Medications can help you manage grade 2 spondylolisthesis, making it easier to get through the day. Although taking medication isn’t a cure for spondylolisthesis, it’s a temporary solution that can complement the benefits of other treatment methods. Options include:

  • NSAIDs (non-steroidal anti-inflammatory drugs) curb prostaglandin production to reduce inflammation and pain. They can provide temporary relief from spondylolisthesis pain and are widely available over the counter. 
  • Steroid medications reduce inflammation and dampen your immune response, which may provide temporary pain relief. Your doctor may recommend oral steroids or epidural steroid injections, depending on your situation. 
  • Muscle relaxants can help calm the muscle tension and spasms often associated with spondylolisthesis. Keep in mind that in the U.S., muscle relaxants are only available with a prescription. 

Surgical Options for Grade 2 Spondylolisthesis: When and How

Surgical options for grade 2 spondylolisthesis may be recommended when conservative methods fail to resolve your symptoms after several months. Options include:

  • Spinal decompression

If grade 2 spondylolisthesis results in compressed spinal nerves, surgical decompression is an option to consider. The most common form of spinal decompression for spondylolisthesis is laminectomy, which involves removing some or all of the lamina to alleviate pressure on impinged nerves. The laminae are arched pieces of bone that cover the back of the spinal canal. 

Other forms of spinal decompression surgery that may be done for spondylolisthesis include discectomy (involves removing damaged spinal disc tissue) and foraminotomy (widens the openings through which nerve roots leave the spine). 

  • Spinal fusion

Spinal fusion is the go-to procedure for spondylolisthesis, as it restores spinal stability. It’s also widely performed after spinal decompression, as decompressing the spine inherently destabilizes it. Fusion involves permanently joining two or more vertebrae using bone graft material, terminating all motion at the fused spinal segment. 

Several spinal fusion methods exist for spondylolisthesis, including:

  • PLIF involves accessing the spine from the back by retracting the back muscles.
  • ALIF involves accessing the spine from the front, through the abdomen.
  • TLIF involves accessing the spine from the back, through the foramen, and is a minimally invasive form of spinal fusion. 
  • XLIF involves accessing the spine from the side and is a minimally invasive option. 
  • Spinal fusion alternatives

Although fusion has long been considered the primary surgical technique for spondylolisthesis, its downsides (including permanently reduced mobility and increased impact on the adjacent vertebrae) have fostered interest in less invasive alternatives. Today, patients have access to spinal fusion alternatives, like the TOPS System, to preserve their mobility and avoid many of the downsides of fusion. 

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The TOPS System is a dynamic implant device that’s FDA-approved to treat degenerative spondylolisthesis with moderate to severe lumbar spinal stenosis. It replaces the tissues removed in spinal decompression surgery, restoring a controlled range of motion while stabilizing the spine. The FDA awarded TOPS a superior-to-fusion claim, illustrating its remarkable benefits for patients requiring surgery for degenerative spondylolisthesis. 

Prognosis and Quality of Life With Grade 2 Spondylolisthesis

The prognosis for grade 2 spondylolisthesis is usually quite good, and with proper treatment, patients can typically achieve a high quality of life. 

Since grade 2 spondylolisthesis is considered low-grade, it affords you and your physician the chance to slow or prevent its progression. At this stage, spondylolisthesis often responds very well to a combination of lifestyle adjustments, physical therapy, and bracing. After a period of rest and conservative treatments, you’ll likely return to all of your regular activities, including exercise. 

While grade 2 spondylolisthesis can be uncomfortable, the future’s still bright. Visit your doctor to learn more about your treatment options and how to preserve your quality of life with this spinal condition.