CERVICAL RETROLISTHESIS

Causes of Cervical Retrolisthesis:

Cervical retrolisthesis is a condition with many causes. Here are the main reasons it happens, written in simple terms:

Aging and wear

As we age, the discs and ligaments in the neck wear out. Discs lose water and flexibility, shrinking in height. Ligaments weaken, too. This can make neck bones (vertebrae) slip backward, causing retrolisthesis.
Osteoarthritis, a joint disease, also plays a role. It breaks down cartilage and forms bone spurs, which can push vertebrae out of place.

Injury or Trauma

Sudden injuries, like whiplash from a car crash, a sports hit, or a fall, can harm the neck’s muscles and ligaments. This damage may cause vertebrae to shift backward.
Repeated small injuries, like those from bad posture, heavy lifting, or looking down too much, can weaken the neck over time and lead to misalignment.

Birth Defects

Some people are born with spine issues that make retrolisthesis more likely. These defects can cause oddly shaped vertebrae, poor alignment, or weak spinal support, increasing the chance of bones slipping later in life.

Disc Problems

Discs act as cushions between neck bones, keeping them in place. If a disc herniates, bulges, or wears down, it can’t do its job well. This may let vertebrae move out of position, causing retrolisthesis.

Weak or Unbalanced Muscles

Weak neck muscles or uneven muscle strength can fail to support the spine properly. Conditions like kyphosis (hunched back) or scoliosis (curved spine) add stress to the neck, making vertebrae more likely to slip.

Health Conditions

Diseases like osteoporosis or rheumatoid arthritis can contribute. Osteoporosis weakens bones, making them more likely to shift. Rheumatoid arthritis causes joint swelling, which can make the spine less stable.

Cervical Retrolisthesis Symptoms:

Cervical retrolisthesis can present with a wide range of symptoms depending on the severity of the displacement and the extent of nerve or spinal cord involvement. The symptoms can appear in the neck or radiate to other parts of the body due to nerve compression. Common symptoms include:

Neck Pain and Stiffness

• Doctors see persistent neck pain as the most common symptom of cervical retrolisthesis. This pain can range from a dull ache to sharp, stabbing pain. Stiffness in the neck often accompanies this pain, limiting the range of motion and making it difficult to turn the head or look up and down.

Radiating Pain (Radiculopathy)

• If the displaced vertebra compresses nearby nerves, it can cause radiating pain down the shoulders, arms, and even into the hands and fingers. This condition, known as cervical radiculopathy, may result in shooting pain, numbness, tingling, or burning sensations along the affected nerve pathway.

Headaches

• Cervical retrolisthesis can lead to tension-type headaches or cervicogenic headaches, which originate from the neck and radiate toward the head. The genesis of these headaches points to muscle tension, nerve irritation, or changes in spinal alignment due to vertebral displacement.

Muscle Weakness and Fatigue

• Compression of spinal nerves can cause weakness in the muscles of the upper extremities, leading to reduced grip strength, arm fatigue, and difficulty performing everyday tasks like lifting objects or typing.

Balance and Coordination Issues

• In severe cases, cervical retrolisthesis may compress the spinal cord, leading to balance problems, difficulty walking, or impaired coordination. These describe more serious symptoms and may indicate that the spinal cord appears compromised.

Numbness and Tingling

• Numbness and tingling in the upper extremities, particularly the arms and fingers, can appear from nerve root compression caused by the misaligned vertebrae. This sensory loss may occur with a “pins and needles” sensation.

Diagnosis Methods:

Doctors believe that an accurate diagnosis of cervical retrolisthesis will also provide the prerequisite for developing an effective treatment plan. The diagnostic process involves a combination of patient history, physical examination, and imaging studies.

Patient History

• Doctors need a detailed medical history to understand the patient’s symptoms, their onset, and any potential causes, such as trauma or degenerative conditions. The clinician will inquire about the patient’s level of pain, location, and any history of injuries or underlying conditions like arthritis.

Physical Examination

• A physical examination will focus on evaluating the range of motion in the neck, muscle strength in the upper extremities, and reflexes. The clinician may also check for signs of nerve compression, such as numbness, tingling, or muscle weakness.
• Special tests, like the Spurling test, may reproduce symptoms of cervical radiculopathy, helping to confirm the involvement of nerve roots.

Imaging Studies

Imaging provides a key component of diagnosing cervical retrolisthesis. Common imaging modalities include:

• X-rays: X-rays are typically the first imaging test ordered to assess the alignment of the cervical vertebrae. Lateral (side-view) X-rays can reveal the degree of vertebral displacement, as well as the presence of bone spurs or disc degeneration.
• MRI (Magnetic Resonance Imaging): An MRI provides a more detailed view of the soft tissues, including the intervertebral discs, spinal cord, and nerve roots. It helps identify nerve compression, herniated discs, or any damage to the spinal cord caused by retrolisthesis.
• CT Scan (Computed Tomography): CT scans provide detailed images of the bony structures in the spine. Doctors may use this imaging modality to look for fractures, bone spurs, or severe degenerative changes.
• Flexion and Extension X-rays: These specialized X-rays show the patient while moving their neck through flexion (bending forward) and extension (bending backward). These images help assess the stability of the cervical spine and the extent of vertebral displacement during movement.

Electromyography (EMG) and Nerve Conduction Studies

• If doctors think nerves are affected, they may use electromyography (EMG) and nerve conduction tests to check how nerves and muscles are working. These tests help find where and how badly nerves are being pressed.

Conclusion: Cervical retrolisthesis refers to a condition that can arise due to various causes, including degenerative changes, trauma, and congenital abnormalities. The backward displacement of the vertebrae can lead to a variety of symptoms, ranging from neck pain and stiffness to more severe complications like nerve compression and muscle weakness. An accurate diagnosis requires a comprehensive assessment involving patient history, physical examination, and advanced imaging techniques. Early diagnosis and appropriate intervention help manage symptoms and prevent further complications associated with this condition.

Cervical Retrolisthesis Treatment Options:

The management of cervical retrolisthesis is multifaceted, aiming to alleviate symptoms, restore spinal stability, and improve the overall quality of life for affected individuals. Additionally, conservative approaches provide the initial line of treatment and may include physical therapy, pain management, and exercise programs designed to strengthen the supporting muscles and improve posture. In addition, doctors may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants to manage pain and inflammation.

Non-Surgical Treatments for Cervical Retrolisthesis

Non-surgical options aim to control symptoms, reduce swelling, improve function, and stop the condition from worsening. These are best for mild to moderate cases without major nerve or spinal cord issues.

Physical Therapy

Physical therapy is one of the cornerstones of non-surgical treatment for cervical retrolisthesis. It focuses on strengthening the muscles surrounding the neck and improving flexibility to help stabilize the spine and reduce the strain on the affected vertebrae.

• Strengthening Exercises: Therapists design specific exercises that target the muscles supporting the cervical spine, particularly the deep neck flexors and the muscles of the upper back and shoulders. Stronger muscles help alleviate pressure on the vertebrae and improve spinal stability.
• Stretching and Flexibility: Gentle stretching exercises improve the range of motion in the neck, reduce stiffness, and alleviate muscle tension. Proper stretching can also relieve pressure on compressed nerves.
• Posture Correction: Poor posture, such as forward head posture, can exacerbate cervical retrolisthesis by increasing strain on the cervical vertebrae. Physical therapy programs often emphasize correcting posture through awareness, ergonomic adjustments, and specific exercises.
• Manual Therapy: Some physical therapists employ manual therapy techniques, including soft tissue mobilization, joint mobilization, and myofascial release, to alleviate muscle tension, enhance mobility, and reduce pain in the cervical spine.

Medications

Medicines help manage pain and swelling in cervical retrolisthesis.

• Pain Relievers (NSAIDs): Drugs like ibuprofen or naproxen reduce pain and swelling for short-term relief.

• Muscle Relaxers: These ease muscle spasms and stiffness, improving movement and comfort.
• Steroids: For severe swelling or nerve issues, steroids may be taken by mouth or injected to reduce inflammation around nerves.
• Other Pain Relievers: Drugs like acetaminophen help with pain. Stronger medicines may be used briefly for severe cases, but only with caution.

Cervical Traction Devices

Traction gently stretches the neck to reduce pressure on bones, discs, and nerves.

• Clinical Traction: Therapists or chiropractors use devices or their hands to stretch the neck, creating space between bones to ease nerve pressure.
• Home Traction Devices: Patients can use these under a doctor’s guidance to gently stretch the neck, but supervision is key to avoid injury.</p

Bracing and Immobilization

For sudden cases or after injury, a neck brace may be used briefly to limit movement and help the spine heal. Long-term use is avoided to prevent muscle weakening.

• Short-Term Use: Bracing is generally recommended for short-term use, as prolonged immobilization can lead to muscle weakening. Braces are typically worn during the acute phase of injury or after certain procedures.

Lifestyle Modifications and Ergonomic Adjustments

Certain changes can help prevent worsening symptoms:

• Posture: Good posture while sitting, standing, or working reduces neck strain. Use supportive chairs and adjust screen height to avoid leaning forward.
• Activity Changes: Avoid heavy lifting or long phone use. Low-impact activities like walking or swimming keep you fit without harming your neck.

Surgical Treatments for Cervical Retrolisthesis

Treatment for cervical retrolisthesis focuses on easing symptoms, stabilizing the spine, and improving life quality. Simple treatments are usually tried first, like physical therapy, pain relief, and exercises to strengthen muscles and fix posture. Doctors may also use medicines like pain relievers or muscle relaxers to reduce pain and swelling.

Anterior Cervical Discectomy and Fusion (ACDF)

ACDF is one of the most common surgical procedures for treating cervical retrolisthesis. It is particularly useful when disc degeneration or herniation contributes to the vertebral displacement and nerve compression.

• Procedure: During ACDF, the surgeon approaches the cervical spine from the front (anterior). The damaged disc between the affected vertebrae is removed (discectomy), and the doctors fuse the vertebrae using a bone graft or synthetic spacer. A metal plate with screws is often used to provide additional stability.
• Indications: ACDF is indicated in cases of significant disc degeneration, nerve root compression, or spinal instability. It aims to decompress the affected nerves and prevent further vertebral movement.
• Recovery: Following ACDF, the patient’s neck is typically immobilized with a brace or collar for several weeks to allow the fusion to heal. Physical therapy is initiated after recovery to restore strength and mobility.

Posterior Cervical Fusion

In some cases, the surgeon may opt for a posterior cervical fusion, which is performed from the back (posterior) of the neck. This procedure is similar to ACDF but is more suited for patients with multi-level instability or posterior ligament damage.

• Procedure: The surgeon stabilizes the cervical spine by fusing the affected vertebrae using bone grafts and metal rods or screws placed at the back of the neck. This prevents further backward slippage and stabilizes the vertebrae.
• Indications: Posterior cervical fusion is indicated for patients with multi-level cervical retrolisthesis, significant instability, or failed anterior fusion.

Cervical Disc Replacement (Artificial Disc)

Cervical disc replacement is an alternative to fusion that preserves motion between vertebrae while relieving symptoms of retrolisthesis. It is typically indicated in cases where disc degeneration is the primary cause of vertebral displacement.

• Procedure: The damaged intervertebral disc is removed, and an artificial disc is implanted between the vertebrae. Unlike fusion, which eliminates movement, artificial disc replacement allows the patient to retain motion in the affected segment.
• Indications: Disc replacement is considered in younger patients with isolated disc degeneration who prefer to preserve mobility. However, doctors are hesitant to use it for patients with severe instability or advanced degenerative changes.

Laminectomy or Laminoplasty

In cases of severe nerve compression or spinal stenosis due to cervical retrolisthesis, doctors will use a laminectomy or laminoplasty to decompress the spinal cord or nerve roots.

• Laminectomy: The surgeon removes part of the vertebral bone (lamina) to create more space for the spinal cord and nerve roots. This reduces pressure and alleviates symptoms caused by nerve compression.
• Laminoplasty: In this procedure, the lamina is cut and restructured to enlarge the spinal canal without removing it entirely. This preserves spinal stability while creating more space for the spinal cord.
• Indications: These procedures are indicated when there is significant spinal cord compression. Especially when it leads to myelopathy (spinal cord dysfunction) or severe neurological symptoms.

Foraminotomy

Foraminotomy is a surgical procedure aimed at enlarging the foramen, the openings through which nerve roots exit the spine. It is performed to relieve nerve compression caused by retrolisthesis or degenerative changes.

• Procedure: The surgeon removes bone spurs, disc material, or other structures that are narrowing the foramen.  This allows the compressed nerve to exit the spinal canal more freely.
• Indications: Foraminotomy is indicated when nerve root compression is causing radiculopathy (pain radiating down the arm), weakness, or numbness, and conservative measures have failed.

Time to Recuperate:

The recovery period for cervical retrolisthesis varies based on the chosen treatment approach and the individual patient’s response. Conservative treatments require several weeks to months for noticeable improvements as patients engage in physical therapy and lifestyle modifications. Surgical recovery timelines depend on the complexity of the procedure, ranging from a few weeks to several months before patients resume normal activities. Rehabilitation and postoperative care are integral components of the recovery process to ensure optimal outcomes.

Expert Opinions and Insights:

Top docs in the field note the need for a key way to treat a neck bone slip. Dr. Richard A. Hostin, a well-known spine doc, says that a correct diagnosis of the ill is a guide to help. Knowing the one-of-a-kind cause for each illness is key. Making care plans to fit a few main signs of the ill leads to the best ends

Devesh Ramnath, MD, and Ishaq Syed, MD, two prominent spine surgeons at Southwest Scoliosis and Spine Institute, highlight the role of conservative measures in managing cervical retrolisthesis. Both will state that “Physical therapy plays a pivotal role in strengthening the muscles that support the spine. By addressing muscle problems and promoting proper posture, we accelerate healing after a surgical procedure.”

The Southwest Scoliosis and Spine Institute Difference:

Patients facing cervical retrolisthesis wonder why they should choose the physicians at the Southwest Scoliosis and Spine Institute for their care. This institute stands out for its commitment to excellence in spine care. Overall, it relies on a team of highly skilled and experienced spine specialists. Richard Hostin, MD, the institute’s lead spine surgeon, emphasizes a patient-centered approach.

“At Southwest Scoliosis and Spine Institute, we prioritize personalized care for each patient. Our team collaborates to develop tailored treatment plans, considering the unique aspects of every case. From conservative approaches to advanced surgical techniques, we dedicate ourselves to providing comprehensive care to individuals affected by cervical retrolisthesis,” says Dr. Hostin.

Moreover, the institute boasts state-of-the-art facilities, cutting-edge diagnostic methods, and a diverse team of experts. Furthermore, the team includes spine surgeons, physical therapists, and pain management specialists. The institute’s holistic approach ensures that patients receive great care for all aspects of their condition.

In conclusion, cervical retrolisthesis is a complex spinal disorder with diverse causes, symptoms, and treatment options. Finally, a thorough knowledge of this condition, coupled with expert opinions and evidence-based data, is crucial for people navigating the challenges posed by this condition. Finding a reputable spine institute, such as the Southwest Scoliosis and Spine Institute with offices in Dallas, Plano, and Frisco, Texas, requires lots of research. Picking us ensures that patients receive top-notch care from a team dedicated to optimal outcomes for those affected by this spinal condition.

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Citation: Healthline: Cervical Retrolisthesis

The medical content on this page has been carefully reviewed and approved for accuracy by the Southwest Scoliosis and Spine Institute’s qualified healthcare professionals, including our board-certified physicians and Physician Assistants. Our team ensures that all information reflects the latest evidence-based practices and meets rigorous standards of medical accuracy, with oversight from our expert spine doctors to guarantee reliability for our patients.