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Cervical Isthmic Anterolisthesis

Dr. Lisa S. Apfel MD - Spine and Neurosurgery Dr. Lisa S. Apfel MD - Spine and Neurosurgery
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Degenerative Bones, Joints, and Spine Care (A - Z)

Cervical Isthmic Anterolisthesis is a rare spinal condition in which one of the cervical (neck) vertebrae slips forward (anterolisthesis) relative to the one below it due to a defect or fracture in the pars interarticularis (isthmus) of the vertebra. This defect weakens the vertebral arch, allowing the vertebral body to shift forward, potentially causing neck pain, nerve irritation, or instability WikipediaE-Neurospine.

Anatomy

Structure and Location

The cervical spine consists of seven vertebrae (C1–C7). Isthmic anterolisthesis most often involves the typical cervical vertebrae (C3–C7), where the pars interarticularis—a small bony segment between the superior and inferior articular facets—is located. In cervical isthmic defects, the pars at this level is fractured or elongated, most commonly at C6–C7, allowing forward slipping of the affected vertebra E-NeurospineWikipedia.

Origin and Insertion

Although “origin” and “insertion” usually describe muscle attachments, for cervical vertebrae these terms can refer to the attachment sites of ligaments and joint capsules. The pars interarticularis serves as the attachment point for the interspinous ligaments (origin) and the ligamentum flavum (insertion), which help maintain vertebral alignment and flexibility Wikipedia.

Blood Supply

The cervical vertebrae receive blood from branches of the vertebral, ascending cervical, and deep cervical arteries. These vessels form an extensive collateral network around the vertebral bodies and arches. The vertebral artery, traveling through the transverse foramina of C1–C6, contributes significantly to perfusion of the cervical spine and the spinal cord NCBICleveland Clinic.

Nerve Supply

Sensory innervation of the cervical spine originates from the cervical spinal nerves (C1–C8). Each nerve gives off a sinuvertebral branch that supplies the corresponding vertebral body, intervertebral disc, and facet joints. Irritation of these nerves by slipping vertebrae can lead to radicular pain or sensory disturbances in the upper limbs Osmosis.

Functions

  1. Support: Bears the weight of the head and transmits loads to the thoracic spine.

  2. Protection: Encloses and safeguards the cervical spinal cord.

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

  4. Muscle Attachment: Provides attachment sites for neck muscles and ligaments.

  5. Neurovascular Passage: The transverse foramina allow safe passage of vertebral arteries and veins.

  6. Shock Absorption: Intervertebral discs between vertebral bodies cushion forces during movement NCBIPhysioPedia.

Types

Cervical anterolisthesis can be categorized by cause:

  • Dysplastic (Type I): Congenital abnormalities of facet joints or pedicles.

  • Isthmic (Type II): Fracture or elongation of the pars interarticularis (as in Cervical Isthmic Anterolisthesis).

  • Degenerative (Type III): Age-related facet joint arthritis and disc degeneration leading to slipping.

  • Traumatic (Type IV): Acute fractures in neural arch structures other than the pars.

  • Pathologic (Type V): Slippage due to bone infection or tumor erosion.

  • Iatrogenic (Type VI): Resulting from prior cervical spine surgery Wikipedia.

Causes

  1. Congenital pars dysplasia

  2. Stress fractures from repetitive neck hyperextension

  3. Acute neck trauma (e.g., vehicular accident)

  4. Hangman’s fracture of C2

  5. Degenerative facet arthritis

  6. Intervertebral disc degeneration

  7. Osteoporosis weakening bony structures

  8. Rheumatoid arthritis affecting facets

  9. Ankylosing spondylitis with fusion stresses

  10. Spinal tumors (primary or metastatic)

  11. Vertebral osteomyelitis (infection)

  12. Chronic corticosteroid use leading to bone fragility

  13. Genetic collagen disorders (e.g., Ehlers–Danlos syndrome)

  14. Congenital spinal bifida occulta combined with pars defect

  15. Poor bone healing after childhood vertebral fractures

  16. Excessive weightlifting or heavy occupational loads

  17. Sports involving repetitive hyperextension (gymnastics)

  18. Smoking-induced bone demineralization

  19. Radiation therapy weakening vertebrae

  20. Prolonged immobilization leading to muscle atrophy and instability E-NeurospineCleveland Clinic.

Symptoms

  1. Gradual onset neck pain

  2. Stiffness in the cervical region

  3. Muscle spasms in the trapezius or paraspinals

  4. Clicking or clunking sensations with movement

  5. Headaches at the base of the skull

  6. Shoulder or scapular pain

  7. Arm pain following a dermatomal pattern

  8. Numbness or tingling in arms/hands

  9. Weakness in grip or arm muscles

  10. Radiating pain into fingers

  11. Sensory disturbances (burning or pins-and-needles)

  12. Dizziness or imbalance (vertebrogenic)

  13. Difficulty turning the head fully

  14. Facial pain due to cervical nerve root irritation

  15. Increased pain on neck extension

  16. Muscle atrophy in chronic cases

  17. Gait disturbances if myelopathy develops

  18. Loss of fine motor skills

  19. Bowel or bladder changes in severe myelopathy

  20. Sleep disturbance from nocturnal pain E-NeurospineCleveland Clinic.

Diagnostic Tests

  1. Lateral Cervical X-ray: Detects slippage and grade of anterolisthesis E-Neurospine.

  2. Flexion-Extension X-rays: Assess dynamic instability E-Neurospine.

  3. Computed Tomography (CT): Visualizes pars defects and bony anatomy E-Neurospine.

  4. Magnetic Resonance Imaging (MRI): Evaluates disc, cord, and soft tissues E-Neurospine.

  5. CT Myelogram: Highlights spinal canal and nerve root compression.

  6. Bone Scan (Technetium-99m): Identifies stress fractures or increased bone turnover.

  7. Single-Photon Emission CT (SPECT): Pinpoints active pars stress fractures.

  8. Electromyography (EMG): Assesses nerve root irritation.

  9. Nerve Conduction Velocity (NCV): Quantifies peripheral nerve dysfunction.

  10. Dynamic MRI: Studies cord changes with movement.

  11. Ultrasound Doppler: Evaluates vertebral artery flow in hyperextension.

  12. DEXA Scan: Checks bone density for osteoporosis.

  13. Inflammatory Markers (ESR, CRP): Rules out infection.

  14. Complete Blood Count: Screens for systemic infection or anemia.

  15. Rheumatoid Factor/ANA: Assesses autoimmune arthritis.

  16. Genetic Testing: For collagen vascular disorders.

  17. Discography: Provokes pain to identify symptomatic disc levels.

  18. Functional Outcome Questionnaires: Quantifies disability (NDI).

  19. Ultrasonography: For soft-tissue evaluation.

  20. Clinical Provocative Tests: e.g., Spurling’s maneuver E-Neurospine.

Non-Pharmacological Treatments

  1. Soft cervical collar support

  2. Rigid (hard) cervical orthosis

  3. Physical therapy—strengthening and stretching

  4. Postural education and ergonomics

  5. Cervical traction (manual or mechanical)

  6. Heat therapy (moist heat packs)

  7. Cold therapy (ice packs)

  8. Transcutaneous Electrical Nerve Stimulation (TENS)

  9. Ultrasound therapy

  10. Massage therapy

  11. Acupuncture

  12. Manual mobilization techniques

  13. Cervical stabilization exercises

  14. Core strengthening for posture support

  15. Aquatic therapy

  16. Yoga for neck flexibility

  17. Pilates for core and neck stability

  18. Biofeedback for muscle relaxation

  19. Ergonomic workstation adjustments

  20. Sleep on ergonomic neck pillow

  21. Lifestyle modification (smoking cessation)

  22. Weight management to reduce load

  23. Stress reduction techniques

  24. Cervical proprioceptive training

  25. Avoidance of neck hyperextension activities

  26. Education on safe lifting techniques

  27. Nutritional optimization for bone health

  28. Cognitive-behavioral therapy for chronic pain

  29. Vibration therapy devices

  30. Mindfulness and relaxation exercises E-NeurospineScienceDirect.

Drugs

Drug Class Typical Dosage Timing Common Side Effects
Ibuprofen NSAID 400–800 mg every 6–8 hrs With food GI upset, dizziness
Naproxen NSAID 250–500 mg every 12 hrs With food Headache, fluid retention
Diclofenac NSAID 50 mg every 8 hrs With food Elevated liver enzymes, dyspepsia
Celecoxib COX-2 inhibitor 100–200 mg daily With food Edema, hypertension
Meloxicam NSAID 7.5–15 mg daily With food GI pain, rash
Etoricoxib COX-2 inhibitor 30–60 mg daily With food Dyspepsia, dyslipidemia
Acetaminophen Analgesic 500–1,000 mg every 6 hrs PRN Liver toxicity (in overdose)
Tramadol Opioid agonist 50–100 mg every 4–6 hrs PRN Nausea, drowsiness
Gabapentin Anticonvulsant 300–900 mg TID Bedtime/initiation Dizziness, somnolence
Pregabalin Anticonvulsant 75–150 mg BID BID Weight gain, edema
Cyclobenzaprine Muscle relaxant 5–10 mg TID PRN PRN Dry mouth, sedation
Diazepam Benzodiazepine 2–10 mg TID PRN PRN Dependence, drowsiness
Baclofen Muscle relaxant 5–20 mg TID TID Weakness, fatigue
Tizanidine Muscle relaxant 2–4 mg every 6–8 hrs PRN PRN Hypotension, dry mouth
Prednisone Corticosteroid 5–60 mg daily taper AM Hyperglycemia, immunosuppression
Methocarbamol Muscle relaxant 1,500 mg QID PRN Dizziness, GI upset
Amitriptyline TCA antidepressant 10–50 mg at bedtime Bedtime Anticholinergic effects, weight gain
Duloxetine SNRI 30–60 mg daily AM Nausea, dry mouth
Calcitonin Hormone 200 IU nasal daily Daily Nasal irritation, flushing
Vitamin D/Calcium Supplements Vit D 800 IU + Ca 1,200 mg Daily GI upset, hypercalcemia (rare)
MedscapeCleveland Clinic

Surgical Options

  1. Anterior Cervical Discectomy and Fusion (ACDF): Removes degenerated disc, fuses adjacent vertebrae.

  2. Posterior Cervical Fusion: Uses rods and screws to stabilize.

  3. Laminectomy: Decompresses spinal canal by removing part of the lamina.

  4. Laminoplasty: Expands spinal canal while preserving posterior elements.

  5. Foraminotomy: Enlarges neural foramen to relieve nerve root compression.

  6. Posterior Lateral Mass Screw Fixation: Rigid fixation of posterior column.

  7. Interbody Fusion with Cage: Restores disc height and alignment.

  8. Disc Replacement (Artificial Disc): Maintains segment motion.

  9. Combined Anteroposterior Surgery: For severe instability.

  10. Minimally Invasive Posterior Fixation: Using percutaneous screws E-NeurospineOrthoBullets.

Prevention Strategies

  1. Maintain good neck posture

  2. Strengthen cervical and core muscles

  3. Use ergonomic workstations

  4. Avoid prolonged neck hyperextension

  5. Wear protective gear in sports

  6. Practice safe lifting techniques

  7. Keep a healthy weight

  8. Stop smoking to preserve bone health

  9. Ensure adequate calcium and vitamin D intake

  10. Regular medical check-ups if predisposed PhysioPediaCleveland Clinic.

When to See a Doctor

  • Sudden increase in neck pain or stiffness

  • New arm weakness or numbness

  • Loss of coordination or balance

  • Bladder or bowel dysfunction

  • Signs of spinal cord compression (e.g., gait instability)

  • Pain unresponsive to 1–2 weeks of conservative care E-Neurospine.

Frequently Asked Questions

  1. What causes cervical isthmic anterolisthesis?
    A defect or fracture in the pars interarticularis, often congenital or from repetitive stress, leads to vertebral slippage E-Neurospine.

  2. How common is it?
    Extremely rare, with fewer than 150 reported cases worldwide, most involving C6–C7 E-Neurospine.

  3. Can it heal without surgery?
    Yes—many stable cases improve with bracing and rehabilitation E-Neurospine.

  4. What imaging is best for diagnosis?
    CT scans precisely show pars defects; MRI evaluates soft tissues and cord involvement E-Neurospine.

  5. Is it painful?
    Some patients have only mild neck pain; others develop radicular symptoms or stiffness E-Neurospine.

  6. Can it cause spinal cord injury?
    In unstable or high-grade slips, there is risk of cord compression and neurologic deficits E-Neurospine.

  7. What non-surgical treatments help?
    Bracing, physical therapy, and activity modification are first-line E-Neurospine.

  8. When is surgery needed?
    For unstable slips, progressive neurologic symptoms, or pain unresponsive to conservative care E-Neurospine.

  9. What is the recovery time after ACDF?
    Typically 6–12 weeks for bony fusion, with return to normal activities in 3–6 months OrthoBullets.

  10. Are there risks of fusion surgery?
    Yes—risk of nonunion, adjacent segment disease, and graft or hardware complications OrthoBullets.

  11. Can disc replacement be used?
    In select cases, to preserve motion at the affected segment OrthoBullets.

  12. Does it affect daily life?
    Mild cases often manage well; severe slips can limit neck movement and activities E-Neurospine.

  13. What exercises are safe?
    Gentle cervical stabilization and range-of-motion exercises under professional guidance PhysioPedia.

  14. Can children have this?
    Rarely, congenital pars defects present in adolescence and may worsen with growth E-Neurospine.

  15. Is there a genetic link?
    No definitive genetic cause, though collagen disorders may predispose some individuals E-Neurospine.

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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  27. https://www.usa.gov/federal-agencies/national-institute-of-arthritis-musculoskeletal-and-skin-diseases
  28. https://www.cdc.gov/niosh/topics/skin/default.html
  29. https://www.mayoclinic.org/diseases-conditions/brain-tumor/symptoms-causes/syc-20350084
  30. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep
  31. https://www.cdc.gov/traumaticbraininjury/index.html
  32. https://www.skincancer.org/
  33. https://illnesshacker.com/
  34. https://endinglines.com/
  35. https://www.jaad.org/
  36. https://www.psoriasis.org/about-psoriasis/
  37. https://books.google.com/books?
  38. https://www.niams.nih.gov/health-topics/skin-diseases
  39. https://cms.centerwatch.com/directories/1067-fda-approved-drugs/topic/292-skin-infections-disorders
  40. https://www.fda.gov/files/drugs/published/Acute-Bacterial-Skin-and-Skin-Structure-Infections—Developing-Drugs-for-Treatment.pdf
  41. https://dermnetnz.org/topics
  42. https://www.aaaai.org/conditions-treatments/allergies/skin-allergy
  43. https://www.sciencedirect.com/topics/medicine-and-dentistry/occupational-skin-disease
  44. https://aafa.org/allergies/allergy-symptoms/skin-allergies/
  45. https://www.nibib.nih.gov/
  46. https://www.nei.nih.gov/
  47. https://en.wikipedia.org/wiki/List_of_skin_conditions
  48. https://en.wikipedia.org/?title=List_of_skin_diseases&redirect=no
  49. https://en.wikipedia.org/wiki/Skin_condition
  50. https://oxfordtreatment.com/
  51. https://www.nidcd.nih.gov/health/
  52. https://consumer.ftc.gov/articles/w
  53. https://www.nccih.nih.gov/health
  54. https://catalog.ninds.nih.gov/
  55. https://www.aarda.org/diseaselist/
  56. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets
  57. https://www.nibib.nih.gov/
  58. https://www.nia.nih.gov/health/topics
  59. https://www.nichd.nih.gov/
  60. https://www.nimh.nih.gov/health/topics
  61. https://www.nichd.nih.gov/
  62. https://www.niehs.nih.gov
  63. https://www.nimhd.nih.gov/
  64. https://www.nhlbi.nih.gov/health-topics
  65. https://obssr.od.nih.gov/
  66. https://www.nichd.nih.gov/health/topics
  67. https://rarediseases.info.nih.gov/diseases
  68. https://beta.rarediseases.info.nih.gov/diseases
  69. https://orwh.od.nih.gov/

References

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