Cervical Spondylolisthesis at C6–C7

Cervical spondylolisthesis at C6–C7 occurs when the sixth cervical vertebra slips forward over the seventh, potentially compressing nerve roots or the spinal cord and causing pain, sensory changes, or weakness in the neck, shoulders, arms, and hands. This condition may be congenital or develop over time due to degeneration, trauma, or systemic disease, and requires a thorough understanding of the anatomy, pathophysiology, and management options to optimize outcomes for patients.

Anatomy

Structure and Location

The C6–C7 motion segment consists of the sixth (C6) and seventh (C7) cervical vertebrae, the intervertebral disc between them, paired facet (zygapophyseal) joints, and supporting ligaments and muscles. C6 has a bifid spinous process and transverse foramina for vertebral arteries; C7’s long spinous process is palpable at the base of the neck and may lack a transverse foramen for the artery WikipediaPhysiopedia.

Origin and Insertion

The intervertebral disc “originates” by anchoring its annulus fibrosus to the edges of the C6 and C7 vertebral endplates, while the anterior longitudinal ligament (ALL) originates at the anterior tubercle of C1 and inserts on the anterior surface of C6–C7, continuing to the sacrum KenhubRadiopaedia. Likewise, the facet joint capsule originates at the rim of the inferior articular process of C6 and inserts on the superior articular process of C7.

Blood Supply

C6–C7 receive blood from branches of the vertebral arteries (transverse foraminal segment usually at C6) and from ascending cervical arteries (branches of the inferior thyroid artery). Small radicular arteries branch off to supply the spinal cord at this level, while the posterior spinal arteries support the dorsal elements PhysiopediaTeachMeAnatomy.

Nerve Supply

Pain-sensitive structures (disc annulus, facet joints, ligaments) at C6–C7 are innervated by the dorsal rami of the C7 spinal nerves. Sympathetic fibers accompany the vertebral artery through the transverse foramina, and the cervical plexus (C1–C4) lies anteriorly but does not directly innervate the motion segment TeachMeAnatomyOHSU.

Functions

1. Support: Bears the weight of the head.

2. Mobility: Allows flexion, extension, lateral bending, and rotation of the neck.

3. Protection: Shields the spinal cord and nerve roots as they exit the spinal canal.

4. Shock absorption: Intervertebral disc cushions vertical and shear forces.

5. Stability: Ligaments (ALL, PLL, ligamentum flavum) and muscles maintain alignment.

6. Load transmission: Transmits axial load from the head to the thoracic spine PhysiopediaVerywell Health.

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Types of Cervical Spondylolisthesis

Cervical spondylolisthesis at C6–C7 can be classified by etiology—dysplastic (congenital), isthmic (pars defect), traumatic (facetal fractures or dislocations), degenerative (disc and facet wear), or pathologic (tumor/infection)—and by direction:

• Anterolisthesis: forward slip of C6 on C7

• Retrolisthesis: backward slip

• Laterolisthesis: lateral slip

Grading by Meyerding system (Grade I = <25% slip through Grade V = >100%) further refines severity Precision HealthNSD Therapy.

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Causes

1. Degenerative disc disease

2. Facet joint osteoarthritis

3. Traumatic “hangman” fracture (C2) with secondary instability

4. Facet dislocation or fracture

5. Renal osteodystrophy (hemodialysis-related bone changes)

6. Congenital pedicle hypoplasia or absence

7. Pars interarticularis defects (isthmic)

8. Connective tissue disorders (Ehlers–Danlos)

9. Inflammatory arthritis (rheumatoid, ankylosing spondylitis)

10. Metabolic bone disease (osteoporosis, Paget’s)

11. Infection (osteomyelitis, discitis)

12. Neoplasm (primary or metastatic spine tumors)

13. Post‐surgical instability (laminectomy, fusion failure)

14. Ligament hypertrophy (ligamentum flavum)

15. Muscle weakness/imbalance

16. Repetitive occupational strain (heavy lifting)

17. Chronic poor posture

18. Obesity (increased axial load)

19. Aging‐related senescence of ligaments and discs

20. Radiation‐induced bone weakening PMCHome.

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Symptoms

1. Neck pain

2. Occipital headache

3. Radicular arm pain (“brachialgia”)

4. Myelopathic signs (clumsy hands)

5. Gait disturbances

6. Hyperreflexia

7. Hoffmann’s sign

8. Spasticity

9. Numbness/tingling in hands

10. Muscle weakness (upper limb)

11. Sensory level changes

12. Balance problems

13. Dysesthesia in arms

14. Bowel/bladder dysfunction (severe cases)

15. Reduced neck range of motion

16. Pain worsening on extension

17. Cervical muscle spasm

18. Lhermitte’s sign (electric shock on neck flexion)

19. Shoulder girdle pain

20. Neck stiffness after rest PMCPrecision Health.

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Diagnostic Tests

1. Lateral cervical X-ray (neutral)

2. Flexion–extension dynamic X-rays

3. Anteroposterior (AP) X-ray

4. Computed tomography (CT) scan

5. Magnetic resonance imaging (MRI)

6. CT myelography

7. Digital subtraction myelography

8. Electromyography (EMG)

9. Nerve conduction studies (NCS)

10. Somatosensory evoked potentials (SSEP)

11. Vertebral artery Doppler ultrasound

12. Bone scan (radionuclide)

13. Discography (provocative)

14. DEXA scan (bone density)

15. Upright MRI (weight-bearing)

16. Dynamic ultrasound for soft tissues

17. EMG/SEP for cord function

18. Myelopathy clinical scoring (Nurick grade)

19. Spurling’s test (clinical)

20. Lhermitte’s sign (clinical) Patient Care at NYU Langone HealthMayo Clinic.

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Non-Pharmacological Treatments

1. Cervical traction (mechanical)

2. Structured physical therapy

3. Postural correction exercises

4. Cervical stabilization exercises

5. Core strengthening

6. Ergonomic workstation adjustments

7. Soft cervical collar use (short-term)

8. Manual therapy / mobilization

9. Chiropractic manipulation

10. Acupuncture

11. Massage therapy

12. Heat therapy (moist)

13. Cold therapy (ice packs)

14. Transcutaneous electrical nerve stimulation (TENS)

15. Ultrasound therapy

16. Dry needling

17. Yoga / Pilates for neck stability

18. Aquatic therapy

19. Mindfulness/relaxation techniques

20. Biofeedback for muscle control

21. Inversion therapy (cervical)

22. Balance training

23. Ergonomic lifting training

24. Avoidance of hyperextension activities

25. Weight management

26. Sleep posture optimization

27. Soft-tissue self-mobilization

28. Kinesio taping

29. Lifestyle modification (smoking cessation)

30. Nutritional support for bone health NSD TherapyPhysiopedia.

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 Medications

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Dietary Supplements

1. Glucosamine sulfate – 1,500 mg/day; supports cartilage matrix; may inhibit cartilage-degrading enzymes PMCMayo Clinic

2. Chondroitin sulfate – 1,200 mg/day; provides proteoglycan substrate; may reduce inflammation

3. Vitamin D3 – 1,000–2,000 IU/day; enhances calcium absorption; supports bone mineralization PubMedUpToDate

4. Calcium carbonate – 1,000 mg elemental Ca/day; strengthens bone; cofactor for bone matrix enzymes

5. Omega-3 fatty acids – 1–3 g EPA/DHA daily; anti-inflammatory (inhibits cytokines) PubMedPubMed

6. Magnesium – 300–400 mg/day; cofactor in bone formation; modulates neuromuscular tone

7. Vitamin K2 – 90–120 µg/day; activates osteocalcin to bind calcium in bone

8. Collagen peptides – 10 g/day; supplies amino acids for disc matrix

9. Curcumin – 500 mg BID; anti‐inflammatory via NF-κB inhibition

10. Boswellia serrata – 300 mg TID; reduces leukotriene-mediated inflammation

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Advanced Drugs (Bisphosphonates & Regenerative)

1. Alendronate (Fosamax) – 70 mg weekly; bisphosphonate; inhibits osteoclasts by blocking farnesyl pyrophosphate synthase NCBINCBI

2. Ibandronate (Boniva) – 150 mg monthly; bisphosphonate; prevents bone resorption GlobalRPH

3. Zoledronic acid (Reclast) – 5 mg IV once yearly; bisphosphonate; osteoclast inhibition via pyrophosphate analog

4. Teriparatide (Forteo) – 20 µg SC daily; PTH analog; stimulates osteoblasts (anabolic) FDA Access DataNCBI

5. Denosumab (Prolia) – 60 mg SC every 6 months; RANKL inhibitor; prevents osteoclast differentiation

6. Platelet-Rich Plasma (PRP) – 2–5 mL autologous SC; growth factors for disc regeneration

7. Mesenchymal stem cells – 1–10 × 10⁶ cells intradiscal; differentiate into nucleus pulposus-like cells

8. Hyaluronic acid – 20 mg IA facet injection; viscosupplement; restores synovial fluid viscosity PubMed

9. Bone Morphogenetic Protein-2 (BMP-2) – used during fusion; osteoinductive; stimulates new bone formation

10. Onabotulinum toxin A – 50–100 U paraspinal injection; reduces muscle spasm via acetylcholine blockade

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Surgical Options

1. Anterior Cervical Discectomy & Fusion (ACDF) – remove disc, insert graft/plate

2. Posterior Cervical Fusion – lateral mass screw-rod fixation

3. Cervical Disc Replacement – motion-preserving prosthesis

4. Cervical Laminectomy – decompress spinal cord

5. Laminoplasty – hinge-door decompression

6. Foraminotomy – widen nerve exit foramen

7. Corpectomy – remove vertebral body for decompression

8. Osteotomy – realign deformity

9. Posterior Cervical Instrumentation – stabilization with screws/rods

10. Combined Anterior‐Posterior Fusion – for high-grade slips

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Prevention Strategies

1. Maintain good posture

2. Ergonomic workstations

3. Regular neck-strengthening exercises

4. Core stabilization

5. Weight management

6. Smoking cessation

7. Avoid repetitive hyperextension

8. Use proper lifting techniques

9. Adequate calcium & vitamin D intake

10. Annual bone density screening in at-risk adults Cleveland ClinicAmazon.

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When to See a Doctor

Seek prompt evaluation if you experience:

• Progressive neurological deficits (weakness, numbness)

• Signs of myelopathy (spastic gait, bladder/bowel changes)

• Severe, unremitting pain unresponsive to conservative care

• Trauma with suspected instability

• Red-flag symptoms: fever, weight loss, night pain PMCMayo Clinic.

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Frequently Asked Questions

1. What is cervical spondylolisthesis?
   It’s the slip of one cervical vertebra over the one below, here C6 over C7, causing pain and potential nerve compression. Cleveland ClinicCleveland Clinic

2. How common is it at C6–C7?
   Rare (2.3% in degenerative series) compared to C3/4 and C4/5. PMC

3. What causes myelopathy in this condition?
   Dynamic cord compression from slip and ligament hypertrophy. PMC

4. Can it worsen without surgery?
   Low‐grade slips often stabilize; high‐grade may progress if untreated.

5. What non-surgical options help most?
   Physical therapy, traction, posture correction, TENS. NSD Therapy

6. Are NSAIDs safe long-term?
   They relieve pain but risk GI/renal side effects; use lowest effective dose.

7. Is cervical disc replacement an option?
   Yes, in select patients to preserve motion.

8. How quickly do I recover after ACDF?
   Most return to light activity in 4–6 weeks; full fusion by 3–6 months.

9. Will fusion eliminate all motion?
   Fusion stops motion at that segment but may increase stress above.

10. Does smoking affect outcomes?
    Yes, it impairs bone healing and increases nonunion risk.

11. Can supplements heal slipped vertebra?
    They support bone health but don’t reverse slip.

12. Is traction effective long-term?
    It may relieve symptoms but not correct the slip permanently.

13. When is surgical fusion necessary?
    Progressive myelopathy, intractable pain, or instability on imaging.

14. Are steroid injections helpful?
    Epidural steroids can reduce inflammation temporarily.

15. Can I drive after surgery?
    Typically after 1–2 weeks, if pain is controlled and motion is safe.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: May 06, 2025.