Cervical Spondylolisthesis Treatment in New Jersey
Neck pain and stiffness can be caused by many different issues. In some cases, one or more of the spinal bones slips out of place, causing chronic neck pain. This condition is known as spondylolisthesis. Learn more about what causes this condition and how it is treated from Centers for Neurosurgery, Spine & Orthopedics (CNSO) throughout Northern New Jersey. CNSO commonly treats all forms of spondylolisthesis.
What Is Cervical Spondylolisthesis?
The human body has seven vertebrae in the neck, known as the cervical spine which are interconnected by joints and held in alignment by ligaments. Cervical spondylolisthesis is a condition that develops when one of these vertebrae slips out of alignment, causing pressure on the surrounding nerves and spinal cord which produces neck pain, and paresthesia, and can lead to paralysis.
Anatomy of the Cervical Spine
The cervical spine is a part of the spinal column. It has seven stacked vertebrae, labeled C1 through C7, that are connected to facet joints. These joints allow the neck to move forward, backward, and twist. Between each vertebra in the cervical spine are intervertebral discs. Made from a ring of fibrous cartilage with a jelly-like substance inside, these discs act as shock absorbers and help the spine move and be flexible. The vertebral column also protects the spinal cord, which carries messages to and from the brain, controlling body movements, sensations, and involuntary functions such as breathing.
Spondylolisthesis can occur at any level of the spine. It happens when there is a laxity of the ligaments surrounding the vertebra which allows the vertebra to move out of its proper position, either anteriorly or posteriorly. Sometimes, spondylolisthesis occurs after there has been a stress fracture of one of the vertebra, a condition known as spondylolysis. There are several types of spondylolisthesis:
This type of spondylolisthesis is caused by osteoarthritis of the spine. Over time, the facet joints and discs in the spine begin to break down, leading to pain, stiffness, and inflammation. Degenerative spondylolisthesis is the most common type of spondylolisthesis.
Isthmic spondylolisthesis is caused by a fracture or defect in the pars interarticularis, a bony structure that connects the facet joints. This type of spondylolisthesis can be caused by repetitive trauma to the spine. Patients who develop this condition usually are athletes who hyperextend the spine, such as gymnasts, divers, or football players.
This type of spondylolisthesis is present at birth. It develops when a baby’s spinal bones do not form correctly in utero.
Traumatic spondylolisthesis is caused by an acute injury. Trauma to the spinal vertebrae can cause dislocation or a fracture in the facet joint or lamina.
Prevalence and Risk Factors
Cervical spondylolisthesis is less common than lumbar, or lower back, spondylolisthesis. Risk factors for spondylolisthesis include:
- Age: Degeneration of the spine is common in older adults and increases the risk of spondylolisthesis.
- Athletic activities: Patients who play sports that put stress on the back and neck are more likely to develop spondylolisthesis.
- Other spine conditions: Conditions that weaken the spinal column, such as spinal tumors, can increase the risk of developing spondylolisthesis.
Identifying Symptoms and Diagnosis
Cervical spondylolisthesis typically is diagnosed by a neurosurgeon or orthopedic spine surgeon after viewing imaging. CNSO is staffed with world class spine experts who will evaluate neck or back pain and provide an evidenced based treatment plan.
Common symptoms of cervical spondylolisthesis include:
- Neck pain
- Pain that radiates to the back of the head or shoulders
- Numbness or tingling feelings in the arms and hands
- Difficulty walking
- Loss of bladder or bowel control
To confirm a diagnosis of cervical spondylolisthesis, a physician will review a patient’s current symptoms and medical history. They will perform a physical exam and order imaging tests, such as X-rays, MRI, or CT scan to check for fractures. An MRI is needed to assess the tissue surrounding the vertebrae. In a few cases, a surgeon or pain management doctor may recommend an electromyogram (EMG) or nerve conduction study if spinal nerve damage is suspected.
The Meyerding Grading System is used to classify the severity of spondylolisthesis. The grade indicates the degree to which one vertebra has slipped forward over the vertebra below it, expressed as a percentage:
- Grade I: 1-24%
- Grade II: 25-49%
- Grade III: 50-74%
- Grade IV: 75-99%
- Grade V: 100%
CNSO takes a conservative approach to neck pain management and treatment, recommending surgery only when necessary. Non-surgical treatments for cervical spondylolisthesis include:
- Rest and activity modification
- Bracing to support the neck
- Structured physical therapy, including exercise and stretching
- Pain management medications as needed
The patient also will need follow-up imaging to ensure the fracture is healing correctly.
If conservative care is not sufficient to relieve symptoms of cervical spondylolisthesis, injection treatments may help. An epidural steroid injection delivers corticosteroid medication directly to the affected area of the cervical spine. This can significantly reduce inflammation and provide long-term pain relief.
Severe cases of cervical spondylolisthesis may require neck surgery, especially if the patient has nerve damage or chronic pain that does not resolve with more conservative treatments. Options for spine surgery include:
Spinal fusion surgery may be a solution for patients with severe spondylolisthesis or when there is spinal instability. This procedure connects two vertebrae using a bone graft and stabilization hardware to hold the cervical spine in the proper position.
The goal of decompression surgery is to relieve pressure on the nerves that run through openings in the spinal column. This can eliminate numbness or tingling that affects the limbs. To alleviate a compressed nerve, a spine surgeon may perform a laminectomy, foraminotomy, or discectomy but spondylolisthesis often requires a fusion in addition to the decompression.
Post-Surgery Care and Recovery
A patient’s post-surgical care plan will depend on the type of procedure they had, their overall health, and their goals for resuming normal activities. Many patients will see a physical therapist during recovery to improve joint flexibility and strengthen the muscles and ligaments around the spine. The chances of recurrence with spondylolisthesis are higher among patients with a higher grade on the Meyerding Grading System. However, continuing exercises and stretches at home after physical therapy is complete can help a patient maintain an active life with less neck pain.
While cervical spondylolisthesis cannot be prevented, there are steps patients can take to protect their spine health. These include:
- Staying active and maintaining a healthy weight
- Using ergonomic supports at work and home
- Wearing a back brace for physical labor, especially repetitive bending, twisting, or lifting
Understanding Cervical Spondylolisthesis in Athletes
Adolescent athletes are more at risk of developing spondylolisthesis than others, especially those who play certain types of sports that require repetitive hyperextension. These include:
Proper physical conditioning and warm-up routines can help prevent injuries such as spondylolisthesis.
Cervical Spondylolisthesis in Older Adults
While cervical spondylolisthesis is less common than lumbar spondylolisthesis, it can develop in older adults as a result of osteoarthritis. Spondylolisthesis may cause neck pain or stiffness, but in its mildest form, patients are asymptomatic and do not realize they have this condition until it becomes more severe.
As a person ages, the intervertebral discs in the spine can dry out, weaken, and lose height. This makes it more difficult for the spinal column to maintain its proper positioning, leading to instability that ultimately causes a vertebra to slip out of place. Cervical spondylolisthesis in older adults also can lead to nerve compression, as a displaced vertebra can press against a nerve root. While non-surgical treatments cannot repair vertebral slippage, it can relieve symptoms and prevent progression which may be a better solution for someone with multiple other illnesses.
Cervical Spondylolisthesis in Children and Adolescents
Spondylolisthesis in children and teens tends to occur during growth spurts. Fortunately, it often can be managed with conservative treatments such as rest, physical therapy, over-the-counter medications, and core-strengthening exercises. It is important to note that spondylolisthesis tends to occur in competitive, high-pressure sports. Young athletes may need to be reminded that they should not play through pain and should be cleared by their healthcare provider before resuming their sport.
Frequently Asked Questions About Cervical Spondylolisthesis
Can Cervical Spondylolisthesis Be Prevented?
There is no definitive way to prevent cervical spondylolisthesis, but staying physically active, maintaining good posture, and using the proper techniques and protective equipment when playing sports all can help reduce a patient’s risk.
Is Surgery the Only Option for Severe Cases?
Mild to moderate cases of cervical spondylolisthesis may be addressed through interventional treatments such as injections and physical therapy. But for moderate to severe cases, CNSO will recommend surgery when imaging reveals flexion and extension of the spine abnormalities, indicating spinal instability or a physical examination reveals spinal cord compression symptoms called, myelopathy or right and left nerve root compression called bilateral radiculopathy.
What Are the Warning Signs of Worsening Spondylolisthesis?
Initially, cervical spondylolisthesis may cause only minor neck pain or discomfort. However, spondylolisthesis that causes a pinched nerve can cause radiculopathy in both upper extremities or if the spinal cord is compressed too much, it can cause quadriplegia as well as affect bowel or bladder function, leading to incontinence. Patients experiencing these symptoms should see a neurosurgeon or orthopedic spine surgeon right away to prevent permanent nerve damage.
Trust CNSO for Cervical Spondylolisthesis Care
At CNSO, patients can be confident in the quality of their care. Serving patients throughout northern New Jersey, CNSO is a leading expert in spine care, offering surgical and non-surgical interventions to treat neck and back pain. The CNSO medical staff uses a collaborative approach to patient-centered care, with a team that includes board-certified orthopedic spine surgeons and neurosurgeons, pain management physicians, rehabilitation specialists, and certified physical therapists. CNSO boasts multiple locations, with sites in Bergen, Essex, Hudson, Morris, and Passaic counties. To learn more about cervical spondylolisthesis or request an appointment, contact CNSO today.