Clinical calculator
Meyerding Calculator
Meyerding Classification of Spondylolisthesis
The Meyerding classification grades spondylolisthesis by the percentage of anterior translation of one vertebral body over the one below, measured on a standing lateral radiograph, from grade I at 25% or less through to grade V, spondyloptosis, beyond 100%.
What the Meyerding score means
Meyerding scores run from 0 to 100, where a lower score is better. The bands below are conventional reporting categories, not diagnostic cut-offs.
- Grade I0–25
Slip of 25% or less. Usually managed non-operatively; the great majority of degenerative and isthmic slips fall here.
- Grade II25.01–50
Slip between 26% and 50%. Non-operative management remains usual, with surgery considered for persistent symptoms or progression.
- Grade III50.01–75
Slip between 51% and 75%. High-grade; surgical stabilisation is commonly considered, particularly in the skeletally immature.
- Grade IV75.01–100
Slip between 76% and 100%. High-grade, usually symptomatic and usually managed surgically.
- Grade V — spondyloptosis100.01–1000
The vertebral body has translated completely off the one below. Rare, and a complex reconstructive problem.
Published criteria and reliability
The published cut-offs that define this instrument, and the measured agreement between observers using it. Each is reported with the population it was derived in.
| Type | Value | Subscale | Population | Follow-up | Source |
|---|---|---|---|---|---|
| Criterion | Grade I — 0 to 25% | — | Standing lateral radiograph | — | Meyerding HW 1932 |
| Criterion | Grade II — 26 to 50% | — | Standing lateral radiograph | — | Meyerding HW 1932 |
| Criterion | Grade III — 51 to 75% | — | Standing lateral radiograph | — | Meyerding HW 1932 |
| Criterion | Grade IV — 76 to 100% | — | Standing lateral radiograph | — | Meyerding HW 1932 |
| Criterion | Grade V (spondyloptosis) — greater than 100% | — | Standing lateral radiograph | — | Koslosky E 2020 |
| Criterion | Grades I–II are conventionally low-grade and III–V high-grade | — | Clinical and surgical decision-making | — | Koslosky E 2020 |
Criterion is a published cut-off, definition or performance figure belonging to a classification or decision rule — it is not a change score and should not be read as one.
How the score is calculated
Stated in full so the calculation can be independently checked, and reproduced by hand if needed.
The superior endplate of the vertebra below the slip is divided into four equal parts. The grade is determined by which quarter the posterior margin of the superior vertebral body has translated into: grade I is a slip of 25% or less, grade II 26–50%, grade III 51–75%, grade IV 76–100%, and grade V — spondyloptosis — is complete translation beyond 100%, where the vertebral body has dropped off the one below. Numerically, slip percentage = (anterior translation ÷ anteroposterior width of the inferior endplate) × 100.
Instrument profile
- Developer
- Henry W. Meyerding
- Institution
- Mayo Clinic, Rochester, Minnesota
- First published
- 1932
- Response format
- Percentage slip, entered directly or derived from two measurements
- Score range
- 0 to 100
- Direction
- Lower score = better
- Completion time
- About 1 minutes
- Age range
- Children and adults
- Regions
- Spine
- Conditions
- Spondylolisthesis, Isthmic spondylolisthesis, Degenerative spondylolisthesis, Spondylolysis, Spondyloptosis
- Procedures
- Spinal fusion, Decompression, Reduction and instrumentation
- Observer agreement
- Interobserver agreement is good for the grade and moderate for the exact percentage
- Validity
- Correlates with symptom severity and with the likelihood of requiring surgery, and the low-grade versus high-grade split is the distinction that drives management.
- Reliability
- The grade is measured reliably but describes only translation. Slip angle, pelvic incidence and overall sagittal balance are not captured, and in high-grade slips those parameters influence surgical planning more than the Meyerding grade does. Supine imaging systematically understates the slip.
When to use the Meyerding
Well suited to
- Grading and following spondylolisthesis on serial standing lateral radiographs.
- Communicating severity in referrals, operation notes and research, where the grade is universally understood.
Limitations and poor fits
- On supine radiographs, CT or MRI without noting the position, because the slip partially reduces when the patient lies down.
- As a complete surgical planning assessment for high-grade slips, where slip angle and spinopelvic parameters matter more.
- For retrolisthesis, which the classification was not designed to grade.
Meyerding compared with other instruments
Instruments measuring a related construct, with the practical difference between them.
| Instrument | Items | Range | What it adds |
|---|---|---|---|
| ODI | 10 | 0–100 | The Oswestry Disability Index measures how far low back pain restricts ten everyday activities, scoring each section from 0 to 5 and expressing the total as a percentage from 0% (no disability) to 100% (maximum disability). |
| SINS | 6 | 0–18 | The Spinal Instability Neoplastic Score grades the mechanical stability of a spine affected by tumour by adding six components — location, mechanical pain, lesion quality, alignment, vertebral body collapse and posterolateral involvement — to a total from 0 to 18, where 0 to 6 is stable, 7 to 12 is indeterminate and 13 to 18 is unstable, and any total of 7 or more warrants surgical consultation. |
Copyright and permitted use
Published openly because it is the question every clinician and researcher asks before using an instrument, and almost nobody answers it.
A published radiographic measurement and grading method. Freely reproducible; no licence is required.
References
- Meyerding HW. Spondylolisthesis. Surgery, Gynecology and Obstetrics. 1932.
- Koslosky E, Gendelberg D. Classification in brief: the Meyerding classification system of spondylolisthesis. Clinical Orthopaedics and Related Research. 2020.PMID 32168057
Editorial status
This page has not yet been signed off by a named clinical reviewer. The scoring logic is stated in full above so it can be independently verified, and every threshold is traceable to its source. See our editorial methodology.