Assessment
- Spinopelvic parameters
- 36 inch radiograph AP and lateral
- Ensure knees straight
- Arms up : to prevent anterversion
- heads of femur visible
Classification
Classification | Based on parameter | Advantages | Disadvantages/limitations |
Meyerding | Slip Grade | 1. Easy to use2. Can track anatomic progression over time3. Good interobserver reliability | 1. Not able to predict progression2. Slip severity does correlate with severity of symptoms |
Wiltse | Anatomic and etiology | Descriptive type of classification | Not able to predict progression or aid in surgical management |
Marchetti-Bartolozzi | Dysplasia | 1. Predicts prognosis2. Early surgical management in dysplastic type | Not able to predict progression |
SDSG | Slip grade and spino-pelvic alignment | 1. Guide in surgical planning2. Has been shown to have association with QOL3. Most promising classification | 1. Poor interobserver reliability in Type 1–32. Difficult to identify sacral dome in dysplastic type3. Does not take into account LSK |
Wiltse, Newman, and MacNab aetiological classification
- Isthmic (Most common at L5/S1)
- Type A: Defect in pars
- Type B: Healed defect with elongation of pars
- Type C: Acute bilateral fracture
- Degenerative (Most common at L4/5)
- Disc and facet degeneration
- Dysplasia
- Dysplasia of L5/S1 junction
- Wedging of small dysplastic L5
- Dome-shaped upper S1 vertebral border
- Horizontal orientation of L5/S1 facets
- Mimics isthmic type
- Traumatic
- Aihara classification
- Pathological
- Metabolic bone disease
- Connective tissue disease
- Infection
- Neoplasia
The Meyerding classification
- Low grade:
- The end plates are parallel
- Grading
- Grade 1 is 1– 25%
- Grade 2 is 26– 50%
- High grade:
- There is kyphosis at the listhesis level
- Grading
- Grade 3 is 51– 75%
- Grade 4 is 76– 100%
- Grade 5 is spondyloptosis
- Severe slippage and complete malalignment of the vertebral bodies.
- Higher chances of:
- Progression
- Necessitating surgery
Marchetti-Bartolozzi classification
- Focuses on age of onset and underlying cause (developmental or acquired)
- Acquired
- Traumatic
- Acute fracture
- Stress fracture
- Iatrogenic (Postsurgical)
- Direct
- Indirect
- Pathological
- Local
- Systemic
- Degenerative
- Primary
- Secondary
- Developmental
- High dysplasia
- With/without lysis
- With/without elongation
- Low dysplasia
- With/without lysis
- With/without elongation
Spinal Deformity Study Group classification: Mac-Thiong 2008
- This classification is not used for degenerative spondylolisthesis or L4-L5 pathology.
- No clinical significance yet just a nomenclature for now
Type | Slip grade | Sacropelvic balance | Global spinopelvic balance |
Type 1 | < 50% | Low pelvic incidence (< 45°) | ㅤ |
Type 2 | < 50% | Normal pelvic incidence (45°-60°) | ㅤ |
Type 3 | < 50% | High pelvic incidence (> 60°) | ㅤ |
Type 4 | > 50% | Balanced (high sacral slope/low pelvic tilt) | Balanced (C7 plumb line between the femoral heads and sacrum) |
Type 5 | > 50% | Retroverted (low sacral slope/high pelvic tilt) | Unbalanced (C7 plumb line anterior to the femoral head or posterior to the sacrum) |
Type 6 | > 50% | Retroverted (low sacral slope/high pelvic tilt) | Unbalanced (C7 plumb line anterior to the femoral head or posterior to the sacrum) |
Feature | Dysplastic (Congenital) | Lytic (Isthmic) |
Pars Interarticularis | Elongated, malformed, no gap | Bilateral defect (gap) |
Facet Joints | Hypoplastic, dysplastic | Normal or hypertrophic |
Scotty Dog Sign X-ray | Distorted anatomy | “Collar” (lucency) present |
CT Bone Detail | Malformed arch | Clear defect in pars |
MRI Pars Interarticularis | No edema, structural anomaly | Gap, possible edema |
Sacral Inclination | Increased, domed sacrum | Normal sacrum |
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