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In the context of spondylolisthesis, the grading system typically ranges from I to IV, with each grade indicating the extent of vertebral slippage. Grade I represents a displacement of less than 25%, while Grade II indicates 25-50% displacement. Grade III involves a 50-75% slip, and Grade IV indicates more than 75% displacement.

Surgical intervention is generally considered when conservative treatments (like physical therapy, medications, and rest) have failed and when there is significant displacement causing neurological symptoms, instability, or significant pain. Grades III and IV imply a more severe degree of displacement that is likely to lead to increased instability of the spine and often involves neurological compromise.

In these cases, surgical options such as spinal fusion may be indicated to stabilize the vertebrae, relieve symptoms, and prevent further progression of the condition. The higher the grade of spondylolisthesis, particularly grades III and IV, the more likely that surgical intervention will be required to address the associated problems effectively. Thus, grades III and IV are typically where surgical management is indicated due to the severity of the condition and the potential complications that may arise if left untreated.