What is High grade spondylolisthesis?

High-grade spondylolisthesis refers to a severe form of vertebral slippage, where the affected vertebra not only shifts forward but also tilts downward in front of the lower vertebra. This condition is commonly seen in the dysplastic variety and is often associated with lysis. The combination of this slip and dip creates a distinct appearance on an anteroposterior (AP) X-ray, known as the “Napoleon hat sign.” Such deformities can lead to significant mechanical posture abnormalities and may also cause neurological deficits.

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