A backward slip of a cervical vertebra—also called cervical retrolisthesis—is a condition where one of the seven neck vertebrae shifts posteriorly (toward the back) relative to the vertebra below it. This misalignment can stretch or compress spinal structures, leading to neck pain, nerve irritation, and reduced stability in the cervical spine MedicineNetMedical News Today.
Anatomy of Cervical Retrolisthesis (Backward Slip of a Cervical Vertebra)
Cervical retrolisthesis occurs when one of the cervical vertebrae (the bones in your neck) slips slightly backward relative to the one below it. The cervical spine consists of seven vertebrae (C1–C7) that stack to support the head, protect the spinal cord, and allow a wide range of motion. Each cervical vertebra has:
Structure & Location: A vertebral body anteriorly (toward the front) and a vertebral arch posteriorly (back), forming a canal for the spinal cord. The lateral masses bear weight and connect to the facet joints. NCBI
Attachments (“Origin/Insertion” for Muscles & Ligaments): Bony processes (spinous and transverse) serve as attachment points for muscles (e.g., the splenius capitis, levator scapulae) and ligaments (e.g., ligamentum flavum, nuchal ligament). Kenhub
Blood Supply: Primarily from the vertebral arteries running through the transverse foramina, supplemented by ascending cervical arteries branching from the thyrocervical trunk. NCBI
Nerve Supply: Sensory and motor innervation via the dorsal (posterior) and ventral (anterior) rami of the cervical spinal nerves (C1–C8). The dorsal rami supply facet joints and paraspinal muscles, while the ventral rami form the brachial plexus for the arms. NCBI
Key Functions:
Support the weight of the head (about 5 kg)
Protect the cervical spinal cord and nerve roots
Allow flexion (nodding), extension (looking up), lateral bending (ear-to-shoulder), and rotation (shaking head “no”) Physiopedia
Maintain postural balance
Transmit loads between the skull and thoracic spine
Absorb shock via intervertebral discs
Types & Grades of Cervical Retrolisthesis
Cervical retrolisthesis is graded by how far the vertebra has slipped backward relative to the one below:
Grade I: < 25% of vertebral body width
Grade II: 25–50%
Grade III: 50–75%
Grade IV: 75–100%
Spondyloptosis: > 100%
Additionally, it may be localized (single level, often C5–C6) or multilevel (two or more adjacent levels). Medical News Today
Common Causes
Degenerative Disc Disease – age-related disc wear Medical News Today
Osteoarthritis (Spondylosis)
Trauma – whiplash, falls
Congenital Spinal Malformations
Ligament Laxity – Ehlers–Danlos syndrome
Repetitive Strain – poor ergonomics
Poor Posture – forward head posture
Rheumatoid Arthritis
Inflammatory Conditions – ankylosing spondylitis
Osteoporosis – weakened vertebrae
Spinal Tumors – primary or metastatic
Infections – osteomyelitis, discitis
Prior Cervical Surgery
Muscle Imbalance – chronic tension or weakness
Obesity – increased axial load
Smoking – impairs disc nutrition
Metabolic Bone Disease – Paget’s disease
Vitamin D Deficiency – poor bone health
Hyperflexion Injuries – sports, accidents
Genetic Predisposition
Characteristic Symptoms
Neck Pain – deep, aching Healthline
Stiffness & Limited Range of Motion
Muscle Spasms
Headaches – cervicogenic MedicineNet
Radiating Pain – into shoulders, arms
Numbness or Tingling – in arms or hands
Muscle Weakness – grip or shoulder strength
Balance Difficulties – if spinal cord is compressed
Dizziness – due to altered cervical proprioception
Difficulty Swallowing (Dysphagia)
Clicking or Popping – facet joint movement
Fatigue – from chronic pain
Reduced Fine Motor Skills
Sensory Changes – hyper- or hypoesthesia
Clumsiness – dropping objects
Loss of Coordination – gait change
Sleep Disturbance – pain at night
Jaw Pain – referred pain
Autonomic Symptoms – sweating, heart rate changes
Myelopathic Signs – hyperreflexia, clonus MedicineNet
Diagnostic Tests
Plain X-rays (Lateral Cervical View) – grades slip HealthCentral
Flexion-Extension X-rays – assess instability
Magnetic Resonance Imaging (MRI) – cord/nerve compression
Computed Tomography (CT) – bone detail
Electromyography (EMG) – nerve root function
Nerve Conduction Studies
Myelography – combined with CT for cord imaging
Bone Scan – rule out infection or tumor
Dual-energy X-ray Absorptiometry (DEXA) – bone density
Blood Tests – ESR, CRP for inflammation/infection
Neurological Exam – reflexes, motor strength
Spurling’s Test – nerve root provocation
Jackson’s Compression Test
Palpation – tenderness over facets
Gait Analysis – detect myelopathy
Cervical Traction Test
Upper Limb Tension Tests
Swallow Study (if dysphagia)
Visual Analog Scale (VAS) for pain
Patient-Reported Outcome Measures (NDI)
Non-Pharmacological Treatments
Physical Therapy – tailored exercises Medical News Today
Cervical Traction
Soft Cervical Collar (short-term)
Posture Correction – ergonomic advice
Heat Therapy
Cold Therapy
Massage Therapy
Acupuncture
Transcutaneous Electrical Nerve Stimulation (TENS)
Chiropractic Mobilization
Yoga & Stretching
Pilates & Core Stabilization
McKenzie Extension Exercises
Dry Needling
Ultrasound Therapy
Laser Therapy
Hydrotherapy (Aquatic Exercise)
Occupational Therapy
Ergonomic Adjustments
Weight Management Programs
Smoking Cessation Support
Stress Management & Relaxation
Biofeedback
Postural Taping
Home Exercise Programs
Orthotic Pillows
Foam Rolling
Functional Training
Manual Joint Mobilization
Spinal Decompression Table Blogs | Specialty Care Clinics
Drug Therapies
| Drug | Class | Typical Dose | Timing | Common Side Effects | Healthline |
|---|---|---|---|---|---|
| Ibuprofen | NSAID | 400–600 mg every 6–8 hr | With meals | GI upset, renal impairment | |
| Naproxen | NSAID | 250–500 mg bid | Morning & evening | GI bleeding, fluid retention | |
| Acetaminophen | Analgesic | 500–1000 mg q6h (max 4 g/day) | PRN pain | Hepatotoxicity (OD) | |
| Diclofenac gel | Topical NSAID | Apply 4 g to neck area 4×/day | PRN | Skin irritation | |
| Cyclobenzaprine | Muscle relaxant | 5–10 mg qhs | Bedtime | Drowsiness, dry mouth | |
| Tramadol | Opioid analgesic | 50–100 mg q4–6 h (max 400 mg/day) | PRN | Nausea, dizziness, dependency | |
| Gabapentin | Antineuropathic | 300–900 mg tid | TID | Somnolence, peripheral edema | |
| Amitriptyline | TCA antidepressant | 10–25 mg qhs | Bedtime | Sedation, anticholinergic effects | |
| Lidocaine patch | Local anesthetic | One patch to painful area 12 hr | Twice daily | Skin irritation | |
| Prednisone taper | Oral corticosteroid | 10–60 mg/day tapered over weeks | Morning | Weight gain, hyperglycemia, osteoporosis | |
| Etoricoxib | COX-2 inhibitor | 60–90 mg once daily | Morning | Cardiovascular risk | |
| Tizanidine | Muscle relaxant | 2–4 mg q6–8 h | PRN spasms | Hypotension, dry mouth | |
| Meloxicam | NSAID | 7.5–15 mg once daily | With food | GI upset, edema | |
| Duloxetine | SNRI antidepressant | 30–60 mg once daily | Morning | Nausea, insomnia | |
| Baclofen | Muscle relaxant | 5–20 mg tid | TID | Weakness, drowsiness | |
| Alendronate | Bisphosphonate | 70 mg once weekly | Morning, empty | Esophagitis, hypocalcemia | |
| Calcitonin | Peptide hormone | 200 IU nasal spray/day | Morning | Rhinitis, flush | |
| Chondroitin sulfate | Symptomatic slow-acting OA drug | 1200 mg daily | With meals | Mild GI upset | |
| Glucosamine sulfate | Symptomatic slow-acting OA drug | 1500 mg daily | With meals | Mild GI upset | |
| Duloxetine | SNRI | 30 mg once daily | Morning | Nausea, somnolence |
Dietary Supplements
Glucosamine Sulfate – 1 500 mg daily Kenhub
Chondroitin Sulfate – 1 200 mg daily
Omega-3 Fish Oil – 1 000 mg daily
Vitamin D₃ – 1 000–2 000 IU daily
Calcium Citrate – 1 000 mg daily (divided doses)
Turmeric (Curcumin) – 500 mg twice daily
Magnesium – 300–400 mg nightly
Collagen Hydrolysate – 10 g daily in water
MSM (Methylsulfonylmethane) – 2 000 mg daily
Boswellia Serrata Extract – 300 mg twice daily
Surgical Options
Anterior Cervical Discectomy & Fusion (ACDF)
Posterior Cervical Laminectomy & Fusion
Cervical Disc Arthroplasty (Artificial Disc)
Posterior Foraminotomy
Corpectomy with Strut Graft
Interbody Fusion with Cage
Pedicle Screw Fixation
Laminoplasty
Spinal Cord Decompression
Osteotomy for Realignment MedicineNet
Prevention Strategies
Maintain Good Posture
Ergonomic Workstation Setup
Regular Neck & Core Strengthening
Avoid Prolonged Forward Head Position
Use Supportive Pillows
Lift Properly with Leg Muscles
Healthy Weight Management
Quit Smoking
Balanced Diet Rich in Calcium & Vitamin D
Frequent Micro-breaks During Desk Work Medical News Today
When to See a Doctor
Persistent Pain lasting more than 4 weeks despite self-care
Neurological Signs: weakness, numbness, tingling in arms/hands
Red Flags: fever, unexplained weight loss, severe trauma
Signs of Myelopathy: gait instability, hand clumsiness
Severe or Worsening Dysphagia or breathing difficulty
Frequently Asked Questions
What exactly is a cervical retrolisthesis?
A backward slip of a neck vertebra by at least 3 mm relative to the one below, causing joint misalignment and possible nerve irritation.Can it heal on its own?
Mild slips (Grade I) often improve with conservative care; higher grades may need surgery.How long does recovery take?
With physical therapy, many improve in 6–12 weeks; fusion surgery requires 3–6 months for solid bone healing.Is surgery always necessary?
No. Surgery is reserved for neurological compromise or intractable pain after 6–12 weeks of non-surgical treatment. MedicineNetWill it worsen over time?
Degenerative causes may slowly progress; good posture and exercise can slow change.Can exercise make it worse?
Improper technique can aggravate it; guided, gentle strengthening is key.Are cervical collars helpful long-term?
Short-term use (1–2 weeks) can ease pain, but prolonged immobilization weakens muscles.What imaging is best?
MRI for soft tissues and nerve roots; dynamic X-rays for instability.Do I need injections?
Facet joint steroid injections can relieve pain for months in select cases.Can I drive?
If neck movement or pain prevents safe control, avoid driving until improved.What work restrictions apply?
Avoid heavy lifting, overhead work, and prolonged head-forward postures until cleared.Is massage safe?
Yes, when performed by a licensed therapist familiar with cervical spine precautions.Can stress worsen symptoms?
Yes; stress increases muscle tension, which can heighten pain.How to sleep comfortably?
Use a cervical pillow that maintains neck curvature and avoid stomach sleeping.When should I consider a second opinion?
If recommended surgery seems premature or you aren’t improving after 12 weeks of guided care.
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.
