A grade 3 or 4 spondylolisthesis is always an absolute contraindication to adjustment.

• A. True
• B. False
• C. Sometimes
• D. Not enough information

Answer: (B)

The key idea is that a high-grade spondylolisthesis is not automatically disqualifying for adjustment. Grade 3 or 4 means substantial forward slip, which raises concern, but whether adjustment is appropriate depends on stability and neurological status. If the slip is stable on imaging and there are no neuro deficits or signs of canal compromise, careful, low-force or non-thrust techniques and rehabilitative care can be considered at the involved level. If there are symptoms like radiculopathy, progressive neurologic changes, or evidence of instability, adjustments should be avoided and medical management pursued. So, it’s not an absolute contraindication; it’s a relative one that requires individualized assessment.