Backword Slip C5 over C6

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 15 min read
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Article Summary

A backward slip of C5 over C6, medically called retrolisthesis, occurs when the fifth cervical vertebra shifts backwards relative to the sixth. This misalignment can narrow spinal canals, pinch nerves, and lead to neck pain, stiffness, and other symptoms. Retrolisthesis is graded by how far the vertebra has slipped—mild (grade I), moderate (grade II), severe (grade III), or complete displacement (grade IV). Anatomy of the...

Key Takeaways

  • This article explains Anatomy of the C5–C6 Motion Segment in simple medical language.
  • This article explains Types of Cervical Spondylolisthesis (Slip) in simple medical language.
  • This article explains Causes in simple medical language.
  • This article explains Symptoms in simple medical language.
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Definition

A backward slip of C5 over C6, medically called retrolisthesis, occurs when the fifth shifts backwards relative to the sixth. This misalignment can narrow spinal canals, pinch nerves, and lead to neck , , and other symptoms. Retrolisthesis is graded by how far the vertebra has slipped— (grade I), (grade II), (grade III), or complete displacement (grade IV).

of the C5–C6 Motion Segment

The C5–C6 motion segment is located in the lower part of the cervical spine, just above the C7 vertebra. It consists of two vertebral bodies (C5 and C6), an intervertebral disc between them, paired facet (zygapophyseal) joints, ligamentous structures (including the anterior and posterior longitudinal , ligamentum flavum, and interspinous ligaments), and surrounding muscles and soft tissues that stabilize and move the segment Spine-healthCleveland Clinic.

  • Structure & Location:

    • Vertebral Bodies: C5 and C6 are roughly the size of a small bean and bear axial load.

    • Facet Joints: Each vertebra has superior and inferior articular facets that interlock, guiding and limiting motion.

    • Disc: Provides cushioning and allows slight motion between C5 and C6.

  • “Origin” & “Insertion” (Articulations):

    • C5’s inferior facets articulate with C6’s superior facets; C6’s inferior facets articulate with C7’s superior facets.

  • Blood Supply:

    • Primarily via small branches of the vertebral and ascending cervical , which penetrate the vertebral bodies and posterior elements Physiopedia.

  • Nerve Supply:

    • Branches of the cervical dorsal rami innervate facet joints, and sinuvertebral nerves supply the disc and ligamentous structures Cleveland Clinic.

  • Key Functions:

    1. Flexion/Extension: Nods and tilts head forward/backward.

    2. Lateral Flexion: Bends head side to side.

    3. Rotation: Turns head left/right.

    4. Load Bearing: Supports head weight (~4.5–5.5 kg).

    5. Absorption: Disc and ligaments absorb forces during movement.

    6. Protecting Neural Elements: Maintains space for the and exiting nerve roots.

Types of Cervical (Slip)

  1. Anterior Slip (Anterolisthesis): Forward displacement of C5 on C6.

  2. Posterior Slip (Retrolisthesis or “Backward Slip”): Backward displacement of C5 relative to C6.

  3. Dysplastic: malformation of facet joints or pars interarticularis.

  4. Isthmic: Defect or of the pars interarticularis (rare in cervical spine).

  5. Degenerative: Age-related disc and facet joint wear causing instability.

  6. Traumatic: injury (e.g., facet , hangman’s fracture) PMCuniversityspinecenter.com.

  7. Pathological: Resulting from tumors, infections, or bone disease.

Causes

  1. Disc degeneration and loss of height PMC

  2. Facet joint arthrosis (wear-and-tear) PMC

  3. Acute (e.g., whiplash, falls) PMC

  4. Congenital malformed facets or pars defects.

  5. causing joint erosion.

  6. weakening bony structures.

  7. Paget’s disease disrupting normal vertebral architecture.

  8. Tumors eroding bone (metastases, primary bone tumors).

  9. Infections (, discitis).

  10. Repetitive microtrauma with sports or heavy .

  11. Poor posture leading to uneven loading.

  12. Obesity increasing axial load.

  13. Smoking impairing disc nutrition.

  14. predisposition to ligamentous laxity.

  15. Hypermobility syndromes (e.g., Ehlers–Danlos).

  16. Prior cervical spine surgery causing altered mechanics.

  17. spondyloarthropathies (e.g., ).

  18. Diffuse skeletal hyperostosis (DISH) stiffening the spine.

  19. Metabolic bone diseases (e.g., osteomalacia).

  20. Iatrogenic injury (e.g., radiation-induced bone loss).

Symptoms

  1. Neck stiffness.

  2. neck pain.

  3. Pain radiating to the shoulder or arm (radiculopathy).

  4. Numbness or tingling in the arm or hand.

  5. Muscle weakness in the upper limb.

  6. Headaches at the base of the skull.

  7. Difficulty turning the head.

  8. Grinding or popping sensations (crepitus).

  9. Feeling of instability in the neck.

  10. Balance problems (if spinal cord is pinched).

  11. Gait disturbance or clumsiness.

  12. Loss of fine motor skills (buttons, writing).

  13. Hyperreflexia (overactive reflexes).

  14. Bowel or bladder dysfunction (rare, late).

  15. Muscle spasms in the neck or shoulder.

  16. Pain with coughing or sneezing.

  17. Worse pain when leaning forward or backward.

  18. Sleep disturbances due to pain.

  19. Fatigue from chronic discomfort.

  20. Anxiety or depression secondary to chronic pain.

Diagnostic Tests

  1. Plain X-rays: Lateral, anteroposterior, flexion/extension views to see slip and instability Mayo Clinic.

  2. MRI Scan: Shows disc, spinal cord, nerve root compression Mayo Clinic.

  3. CT Scan: Detailed bone anatomy to assess facet joints and pars defects.

  4. Myelogram: Dye in spinal canal plus CT to detect nerve compression.

  5. Electromyography (EMG): Assesses nerve conduction and muscle response.

  6. Nerve Conduction Studies (NCS): Measures nerve signal speed.

  7. Bone Scan: Detects stress fractures or tumors.

  8. Flexion–Extension Radiographs: Demonstrate dynamic instability.

  9. Ultrasound: Occasionally for muscle/fascia assessment.

  10. Blood Tests: ESR/CRP for infection or inflammation.

  11. WBC Count: Elevated in infection.

  12. Rheumatoid Factor/ ANA: Autoimmune screening.

  13. DEXA Scan: Bone density to evaluate osteoporosis.

  14. Discography: Reproduces pain by injecting dye into disc.

  15. Somatosensory Evoked Potentials (SSEPs): Measure spinal cord conduction.

  16. Pulmonary Function Tests: Preoperative assessment.

  17. Electrocardiogram (ECG): Preoperative cardiac risk.

  18. Blood Glucose/HbA1c: Preoperative metabolic evaluation.

  19. Nutrition Panel (Albumin): Surgical risk assessment.

  20. CT Angiography: Rarely, if vascular anatomy is needed before surgery.

Non-Pharmacological Treatments

  1. Physical Therapy: Strengthening and stabilization exercises.

  2. Traction: Cervical traction to relieve nerve pressure.

  3. Posture Training: Ergonomic assessment and correction.

  4. Heat Therapy: Relaxes muscles and improves blood flow.

  5. Cold Packs: Reduces inflammation and numbs pain.

  6. Transcutaneous Electrical Nerve Stimulation (TENS).

  7. Massage Therapy.

  8. Acupuncture.

  9. Chiropractic Mobilization (gentle).

  10. Cervical Collar (soft).

  11. Ergonomic Pillows & Mattresses.

  12. Yoga & Pilates (under guidance).

  13. Aquatic Therapy.

  14. Cervical Stabilization Braces.

  15. Dry Needling.

  16. Biofeedback.

  17. Ultrasound Therapy.

  18. Low-Level Laser Therapy.

  19. Kinesio Taping.

  20. Posture-Correcting Devices.

  21. Workstation Ergonomics.

  22. Weight Management.

  23. Smoking Cessation.

  24. Stress Management & Relaxation Techniques.

  25. Activity Modification: Avoid heavy lifting/neck hyperextension.

  26. Cervical Roll Exercises.

  27. Isometric Neck Exercises.

  28. Pilates Ball Stretches.

  29. Neck Strengthening with Resistance Bands.

  30. Education on Safe Lifting and Sleep Positions.

Drugs

Drug Class Dosage Timing Common Side Effects
Ibuprofen NSAID 400–800 mg every 6 h With meals GI upset, heartburn, kidney strain
Naproxen NSAID 250–500 mg twice daily Morning & evening GI bleeding, dizziness
Celecoxib COX-2 inhibitor 200 mg once daily Any time Edema, hypertension
Acetaminophen Analgesic 500–1000 mg every 6 h As needed Liver toxicity (if >4 g/day)
Cyclobenzaprine Muscle relaxant 5–10 mg three times daily At bedtime Drowsiness, dry mouth
Tizanidine Muscle relaxant 2–4 mg every 6–8 h As needed Hypotension, weakness
Gabapentin Antineuropathic 300–600 mg three times daily Titrate up Sedation, peripheral edema
Pregabalin Antineuropathic 75–150 mg twice daily Morning & evening Dizziness, weight gain
Duloxetine SNRI 30 mg once daily Morning Nausea, insomnia
Amitriptyline TCA 10–25 mg at bedtime Bedtime Dry mouth, constipation
Tramadol Opioid agonist 50–100 mg every 4–6 h As needed Nausea, dependence
Oxycodone Opioid agonist 5–10 mg every 4–6 h As needed Constipation, respiratory depression
Prednisone Oral steroid 5–10 mg daily (short use) Morning Weight gain, hyperglycemia
Methylprednisolone Oral steroid taper 4–48 mg daily taper Morning Mood swings, osteoporosis (long)
Lidocaine patch Topical analgesic Apply 1–2 patches daily 12 h on/12 h off Skin irritation
Capsaicin cream Topical analgesic Apply 3–4 times daily Any time Burning sensation
Diclofenac gel Topical NSAID Apply 4 g up to 4× daily Any time Local rash
Methocarbamol Muscle relaxant 1500 mg four times daily As needed Drowsiness
Baclofen Muscle relaxant 5 mg three times daily Titrate up Weakness, drowsiness
Ketorolac NSAID (IV/IM/PO) 10 mg IV/IM, then 20 mg PO Every 6 h (max 5 d) GI bleeding, renal impairment

Dosing may vary by patient weight, age, and comorbidities. Always follow a healthcare provider’s recommendation.

Dietary Supplements

Supplement Typical Dosage Function Mechanism of Action
Glucosamine 1500 mg daily Joint support Precursor for cartilage synthesis
Chondroitin 1200 mg daily Cartilage hydration Stimulates proteoglycan production
Omega-3 (Fish Oil) 1000–3000 mg daily Anti-inflammatory Inhibits pro-inflammatory eicosanoids
Turmeric (Curcumin) 500–2000 mg daily Anti-inflammatory Blocks NF-κB and COX-2 pathways
MSM (Methyl Sulfonyl Methane) 1000–2000 mg daily Pain relief Sulfur donor for connective tissue repair
Vitamin D3 1000–2000 IU daily Bone health Promotes calcium absorption
Calcium 1000–1200 mg daily Bone strength Structural component of bone matrix
Magnesium 300–400 mg daily Muscle relaxation Modulates NMDA receptor activity
Vitamin B12 500–1000 µg daily Nerve health Methylation and myelin synthesis
Collagen Peptides 10 g daily Connective tissue repair Provides amino acids (glycine, proline)

Surgical Options

  1. Anterior Cervical Discectomy & Fusion (ACDF): Remove disc and fuse C5–C6 with bone graft and plate.

  2. Posterior Cervical Fusion: Stabilize from back using rods and screws.

  3. Cervical Laminectomy: Remove lamina to decompress spinal cord.

  4. Laminoplasty: Expand spinal canal by hinging open lamina.

  5. Foraminotomy: Widen nerve root exit foramen.

  6. Total Disc Replacement: Replace disc with artificial implant.

  7. Corpectomy: Remove vertebral body (e.g., C5) and reconstruct with graft.

  8. Osteotomy: Cut and realign vertebra for deformity correction.

  9. Posterior Cervical Laminoforaminotomy: Combined decompression of lamina and foramen.

  10. Minimally Invasive Cervical Fusion: Small incisions and tubular retractor.

Prevention Strategies

  1. Maintain good posture while sitting, standing, and sleeping.

  2. Use ergonomic workstations and chairs.

  3. Strengthen neck and shoulder muscles regularly.

  4. Avoid carrying heavy loads on one side.

  5. Practice safe lifting techniques (lift with legs).

  6. Keep a healthy body weight to reduce spinal load.

  7. Quit smoking to preserve disc nutrition.

  8. Ensure adequate intake of calcium and vitamin D.

  9. Take regular breaks during prolonged desk work.

  10. Use supportive pillows to maintain cervical alignment during sleep.

When to See a Doctor

  • Progressive weakness or numbness in arms or hands.

  • Difficulty walking, balance issues, or falls.

  • Loss of bowel or bladder control.

  • Severe, unremitting pain not relieved by rest or medication.

  • Pain radiating beyond the shoulder into the arm/hand.

 Frequently Asked Questions

  1. What is a backward slip (retrolisthesis)?
    A backward slip occurs when C5 moves posteriorly relative to C6, compressing structures behind it.

  2. How does it differ from anterolisthesis?
    In anterolisthesis, the vertebra slips forward; in retrolisthesis, it slips backward.

  3. Can a backward slip heal on its own?
    Mild slips may stabilize with conservative care, but structural damage often remains.

  4. Are X-rays enough to diagnose it?
    Flexion–extension X-rays show dynamic instability, but MRI/CT define soft tissue and neural involvement.

  5. What activities worsen symptoms?
    Hyperextension (looking up), heavy lifting, and prolonged static postures often aggravate pain.

  6. Is surgery always required?
    No—many patients improve with non-surgical treatments unless neurological deficits progress.

  7. How long is recovery after ACDF?
    Fusion typically takes 3–6 months; return to full activity by 6–12 months under guidance.

  8. Can I exercise with retrolisthesis?
    Gentle, supervised strengthening and range-of-motion exercises are beneficial if approved by your doctor.

  9. What is the role of a cervical collar?
    A soft collar limits extreme motion and can help reduce pain acutely but is not a long-term solution.

  10. Are dietary supplements effective?
    Supplements like glucosamine and turmeric may reduce inflammation but should complement, not replace, medical treatment.

  11. Can retrolisthesis cause headaches?
    Yes—upper cervical instability can refer pain to the base of the skull.

  12. Will weight loss help?
    Reducing body weight decreases axial load on the cervical spine and can relieve symptoms.

  13. Is physical therapy painful?
    Modalities are tailored; some discomfort may occur during strengthening, but pain should not worsen long-term.

  14. How often should I get imaging?
    Follow-up imaging is typically every 6–12 months or sooner if symptoms change.

  15. What is the long-term outlook?
    With proper management, many patients maintain a good quality of life; untreated severe slips can lead to permanent nerve damage.

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.

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Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Orthopedic / spine specialist, physical medicine doctor, or qualified clinician
Tests to discuss with doctor
  • Neurological examination for leg power, sensation, reflexes, and straight leg raise
  • X-ray only if injury, deformity, long-lasting pain, or doctor suspects bone problem
  • MRI discussion if severe nerve symptoms, weakness, bladder/bowel problem, or persistent symptoms
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Is physiotherapy, posture correction, or activity modification needed?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Backword Slip C5 over C6

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

Internal learning pathway

Explore related RX articles

Related guides from RX Harun are grouped to help readers move from overview to symptoms, tests, treatment, and safe next steps.

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  2. Congenital Amegakaryocytic Thrombocytopenia Type 1 (CAMT-1) DefinitionCongenital? amegakaryocytic thrombocytopenia? type 1 (CAMT-1) is a very rare inherited? blood disease present from birth.…
  3. Blue Cone Monochromacy (BCM) DefinitionBlue cone monochromacy (BCM) is a very rare eye disease that a person is born with.…
  4. Is it Okay to Cry in Front of a Psychiatrist? Is It Okay to Cry During a Psychiatric Session? To speak with all honesty – yes.…
  5. Autosomal Dominant Demyelinating Charcot-Marie-Tooth Disease DefinitionAutosomal dominant demyelinating Charcot-Marie-Tooth disease is a long-term nerve disease that mainly damages the peripheral nerves,…
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