By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

High Grade Spinal Instability | Spondylolisthesis

Spinal  instability is common. The bones are not in alignment. The upper vertebrae (bone) shifts forwards as compared to the lower one. Majority of the cases are mild. Occasionally it can be severe. When the vertebra above shifts more than 50% on top of the vertebrae below it is called high grade spondylolisthesis. This problem starts during childhood but may not cause any symptoms until early adulthood.

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High grade spondylolisthesis occurs in children. Sometimes it does not give problem until early adulthood. Symptoms associated with high grade spondylolisthesis are:

  1. Back pain – the muscles of the back need to work harder to maintain the stability of the spine
  2. Painful when bending down – when bending down the weight of the body is pushing the upper bone in worsening direction
  3. Leg pain due to nerve compression – The nerve is irritated by this instability which causes inflammation
  4. Hamstring tightness – The pelvis is tilting backward to stabilise the unstable spine. It causes the hamstring to shorten and to become tight


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The treatment of high grade spondylolisthesis is surgery. The surgery has a few aims:

  1. To reduce the amount of shift of the bone
  2. To stabilise the unstable segment
  3. To free up the nerves

Surgery is performed when the pain has compromised and interfered with the daily activities.

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Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.