What is a spondylolisthesis (In the neck)

Written By Dr. Glenn Corkins, DC, PhD on May 9, 2017

Spondylolisthesis occurs when one vertebra slips forward on the adjacent vertebrae.  Slipping forward is called an anterolisthesis while slipping backward is referred to as a retrolisthesis.  Visually in the flexion radiograph an anterolisthesis looks like figure 1. 

 anterolisthesisFigure1

            A slippage or listhesis can occur anywhere in the spine.   In the lumbar spine, a listhesis is produced by degeneration or trauma.   In the cervical spine, it is almost always caused by trauma.   A degenerative listhesis is the cervical spine is very rare.  The slippage will produce both a deformity of the spine that narrows the vertebral canal affecting the associated nerve as well as abnormal movement.  A listhesis is diagnosed from flexion/ extension radiographs.  The direction and amount of movement is important and determines the seriousness of the injury.  A listhesis in the neck can occur anywhere in the neck from C1 through C7 but always involves two vertebrae.  A listhesis injury is caused by damage to the surrounding support structures, i.e., the ligaments as well as the vertebral disc which can add addition consequences.

 

            Spondylolisthesis are usually caused by motor vehicle accidents when the occupant is whiplashed.   Low speed crashes where little to no damage to the automobile is noted can produce enough force to cause the damage to the ligaments of the neck.  

 

Symptoms:    Neck pain extending toward the shoulders, between the shoulder blades, and pain into the back of the head.  There may also be radicular symptoms with pain, numbness, or weakness traveling into the arms or legs.  A listhesis at C4-C5 has been found to effect cervical nerve C5 important in the innervaton of the rotator cuff muscles.   Suppression of C5 nerve function reduces the effectiveness of the rotator cuff causes impingement problems with loss of shoulder function.   Some injuries are so severe as to cause loss of coordination and bowel or bladder incontinence.   Vertigo is also another common symptom.

 

For some patients, the symptoms may appear for a few days after the accident and then disappear giving the impression that they were not hurt in the crash.  However, the symptoms usually return after several months.  By then your ability to get your medical bills paid by the auto insurance company in Florida is gone.   It is important to get checked out after being an accident no matter how minor you think the crash was.

Treatment:    The best treatment initially is conservative therapy using chiropractic coupled with physical therapy.  When the pain is significant, the use of non-steroidal anti-inflammatory drugs (NSAIDS) will help reduce the pain, such as, Motrin, Ibuprofen, and Naproxen (Aleve).   These drugs are potent long-term pain reducers that work without the side effect for dependence.   However, NSAIDS are well known to have serious side effects for example: 

 

Opioid therapy to control chronic back pain is less acceptable because of the potential toxicity to the body coupled with physical and psychological dependence.   Treatment by this class of drugs should be short term and limited to patients who do not respond to alternatives. 

 

Physical and Chiropractic Therapy:     Physical and chiropractic therapy can play a vital role in your recovery by reducing pain and increase function.  Once acute pain improves, your doctor can design a rehabilitation program to help prevent recurrent injuries and/or help you adapt to any permanent injury you may have acquired due to the accident.   The program often includes heat, cold and electrotherapy to help alleviate pain, decrease swelling, increase strength, and promote healing.   Methods include therapeutic exercise, manual therapy, functional training and use of assistive devices and adaption equipment to increase strength, range of motion endurance, wound healing, and functional independence.  

 

            The goal, of course, is to get you better without the use of drugs with their side effects and/ or surgery with its permanent side effects.  The surgeries to repair whiplash injury are marginally effective and usually the patient trades one problem for another equally bad or worse condition.

 

            At the Advanced Spine Center, we have treated hundreds of patients with spondylolisthesis, often patients with multiple listheses.   We have found an aggressive treatment program will restore the patient to the same or similar work or social activity he or she enjoyed prior to the accident.

 

Consequences of Non-treatment:    If you been in an accident, the consequences of not treating are twofold.    First, the sustained injures from the first accident goes undiagnosed and will become worse with time.   Second, injuries form additional accidents will not be distinguishable from the first.   This can have a major negative impact on the settlement value of any pending medico-legal case because the insurance defense attorney claims “pre-existing condition” for the cause of the injury. 

            The long-term prognosis for untreated whiplash injures is chronic neck and back pain; shoulder pain and/or tingling that extends into the arms and hands; and chronic headaches.   Some patients develop positional vertigo, hypothyroidism, and/or insomnia.    In addition, at the site of injury or ligament laxity there will be underlying degenerative disease which will cause the intervertebral disc to shrink, bone build up on the tops and undersides of the vertebrae, and calcification of the surrounding ligaments.   The degenerative disease is a progressive process that reduces the natural range of motion of the neck, reduces its over function and creates debilitative conditions.   Conservative treatment can prevent and/or prolong these problems.

 

            If you have been diagnosed with a spondylolisthesis, you need to be diligent in treating because this is a very serious condition.   The response to treatment is excellent if the treatment is provided shortly after the accident and is consistent.   Waiting until the acute problem turns into a chronic problem greatly reduces and prolongs the effectiveness of conservative treatments.   Treatment can avoid the high cost of drug therapy with the side effects and/or surgery with its permanent tissue change and loss of function.

 

            From a medical-legal point of view, allowing injuries to go untreated means no documented treatment.   If you get into another accident, the defense lawyers use the first accident against you claiming the injury was all preexisting.    So, it is in the patient’s best interest to have all injuries diagnosed using the latest diagnostic tools available to establish a health status at that point in time.   Any further injury can then be determined using established diagnostic tools, such as, static X-ray, motion X-ray, and standup MRI.

 

            From a medical-legal point of view, partial treatment is the same as not treating at all.   A limited treatment approach will have a negative impact on the case’s settlement value by restricting your attorney’s approach to a reasonable settlement.  If you are concerned about the cost of your medical treatment, talk to your doctor.   In most cases, your financial responsibility is limited to that paid by your insurance, providing you meet their claim requirements.