Backward slip of C6 over C7, also known as C6–C7 retrolisthesis, is a condition in which the sixth cervical vertebra (C6) shifts backward relative to the seventh cervical vertebra (C7). This misalignment can compress nerves, reduce normal spine movement, and cause pain or neurological symptoms.
Anatomy of the C6–C7 Motion Segment
The C6–C7 motion segment consists of the sixth and seventh cervical vertebrae and the intervertebral disc between them. These vertebrae sit at the base of the neck, just above the thoracic spine, and bear much of the head’s weight while allowing extensive flexion, extension, rotation, and lateral bending Spine-health. Each vertebra has a vertebral body anteriorly and a vertebral arch posteriorly, forming the vertebral foramen through which the spinal cord passes Physiopedia.
Origin/Insertion: The vertebrae themselves do not “originate” or “insert” like muscles, but they articulate via superior and inferior articular facets: the inferior facets of C6 articulate with the superior facets of C7, and C7’s inferior facets articulate with T1. These facet joints guide movement and limit excessive rotation.
Blood Supply: Segmental branches of the vertebral and ascending cervical arteries supply the C6–C7 vertebrae and intervertebral disc. Small nutrient arteries penetrate the vertebral bodies, while posterior elements receive branches from muscle perforators Kenhub.
Nerve Supply: Each motion segment receives innervation from the medial branches of the dorsal rami of spinal nerves exiting at that level (C6–C7). These nerves carry pain signals from the facet joints and ligaments to the central nervous system NCBI.
Functions:
Protecting the spinal cord and nerve roots
Supporting head weight and maintaining posture
Allowing flexion/extension (nodding)
Permitting rotation and lateral bending of the neck
Transmitting load between head and thoracic spine
Housing and protecting vertebral blood vessels
Types of Cervical Spondylolisthesis
Degenerative: Age-related facet joint and disc wear causing vertebral slip Cleveland ClinicCleveland Clinic.
Isthmic (Lytic): A defect (spondylolysis) in the pars interarticularis allows slippage.
Traumatic: Acute fracture of posterior elements leads to instability.
Dysplastic (Congenital): Abnormal facet joint formation from birth.
Pathological: Bone disease (e.g., tumor, infection) weakens vertebrae.
Post-surgical: Instability following prior cervical spine surgery.
Causes
Age‐related degeneration of discs and facets Cleveland Clinic
Repetitive flexion‐extension activities (e.g., gymnastics)
High-impact trauma (e.g., falls, motor vehicle accidents)
Congenital facet malformation
Spondylolysis (pars defect)
Osteoporosis weakening vertebrae
Rheumatoid arthritis causing ligament laxity
Tumors (primary or metastatic)
Infections (osteomyelitis, discitis)
Post-operative instability
Smoking-induced disc degeneration
Genetic predisposition to connective tissue laxity
Poor posture over years
Obesity increasing spinal load
Occupational strain (e.g., heavy lifting)
Whiplash injuries
Metabolic bone diseases (e.g., Paget’s)
Disc herniation with facet overload
Facet joint arthropathy
Inflammatory arthritis (e.g., ankylosing spondylitis) Mayo ClinicHospital for Special Surgery
Symptoms
Neck pain (often worse with movement)
Stiffness
Radicular arm pain following the C7 dermatome
Numbness/tingling in the index and middle fingers
Muscle weakness in triceps and wrist extensors
Headaches at the base of the skull
Shoulder pain
Reduced range of motion
Muscle spasm
Balance difficulties
Gait disturbances with myelopathy
Hyperreflexia if spinal cord is compressed
Clonus (rhythmic muscle contractions)
Lhermitte’s sign (electric shock–like sensation)
Fine motor dysfunction (e.g., buttoning shirts)
Bowel/bladder changes (in severe myelopathy)
Sensory loss below the level of lesion
Fatigue from chronic pain
Pain radiating between shoulder blades
Poor hand coordination Mayo ClinicCleveland Clinic
Diagnostic Tests
Physical/neurological exam (reflexes, strength, sensation)
Posture and gait assessment
Cervical range-of-motion measurement
Plain X-rays (AP, lateral, flexion/extension) Mayo Clinic
MRI (soft tissue, spinal cord visualization) Patient Care at NYU Langone Health
CT scan (detail of bony anatomy)
CT myelogram (with contrast to assess canal)
Electromyography (EMG)
Nerve conduction studies
Bone scan (for occult fractures, infection)
DEXA scan (bone density)
Ultrasound (muscle/soft-tissue evaluation)
Facet joint injection (diagnostic block)
Discography (disc pain source)
Myelography
SPECT scan
Dynamic (upright) MRI/X-ray
Blood tests (inflammatory markers)
Tumor markers (if malignancy suspected)
Provocative tests (Spurling’s maneuver) Mayo ClinicNewYork-Presbyterian
Non-Pharmacological Treatments
Physical therapy (strengthening, stabilization)
Cervical traction
Manual therapy (mobilization)
Chiropractic manipulation
Posture correction
Ergonomic workstation adjustments
Heat therapy
Cold packs
Ultrasound therapy
Transcutaneous electrical nerve stimulation (TENS)
Acupuncture
Yoga (neck-friendly poses)
Pilates
Swimming
Cervical collar/brace (short-term use)
Activity modification
Weight management
Hydration and nutrition optimization
Smoking cessation
Relaxation/biofeedback
Cognitive behavioral therapy
Massage therapy
Soft tissue mobilization
Stretching exercises
Proprioception training
Ergonomic pillow/bed support
Isometric neck exercises
Low-impact aerobic exercise
Functional electrical stimulation
Neck bracing during flare-ups Hospital for Special SurgeryCleveland Clinic
Drugs
| Drug | Class | Typical Dosage | Timing | Common Side Effects |
|---|---|---|---|---|
| Ibuprofen | NSAID | 200–400 mg orally every 4–6 h | With meals | GI upset, renal impairment |
| Naproxen | NSAID | 250–500 mg orally twice daily | Morning & evening | GI bleeding, edema |
| Celecoxib | COX-2 inhibitor | 100–200 mg orally daily | Any time | Cardiovascular risk, GI upset |
| Diclofenac | NSAID | 50 mg orally three times daily | With food | Liver enzyme elevation, GI issues |
| Ketorolac | NSAID | 10 mg IV/IM every 6 h (≤5 days) | Hospital use | Bleeding, renal toxicity |
| Acetaminophen | Analgesic | 500–1 000 mg every 6 h (≤4 g/day) | As needed | Hepatotoxicity (overdose) |
| Tramadol | Opioid agonist | 50–100 mg every 4–6 h (≤400 mg/day) | As needed | Dizziness, constipation |
| Gabapentin | Anticonvulsant/neuropathic | 300 mg orally three times daily | With or without food | Sedation, peripheral edema |
| Pregabalin | Anticonvulsant | 75 mg orally twice daily | Morning & evening | Dizziness, weight gain |
| Cyclobenzaprine | Muscle relaxant | 5–10 mg orally three times daily | Bedtime if sedating | Drowsiness, dry mouth |
| Methocarbamol | Muscle relaxant | 500 mg four times daily | With food | Sedation, GI upset |
| Baclofen | Antispasticity agent | 5 mg orally three times daily | With meals | Drowsiness, weakness |
| Amitriptyline | TCA antidepressant | 10–25 mg at bedtime | Bedtime | Anticholinergic effects, sedation |
| Duloxetine | SNRI antidepressant | 30 mg orally daily | Morning | Nausea, headache |
| Prednisone | Corticosteroid | 5–10 mg daily (taper as needed) | Morning | Weight gain, hyperglycemia |
| Methylprednisone | Corticosteroid (dose pack) | 4 mg taper pack over 6 days | Morning | Insomnia, mood changes |
| Hydrocodone/APAP | Opioid combination | 5/325 mg every 6 h as needed | As needed | Respiratory depression, constipation |
| Oxycodone | Opioid agonist | 5 mg every 4–6 h as needed | As needed | Addiction risk, sedation |
| Tizanidine | Muscle relaxant | 2 mg every 6–8 h as needed | With meals | Hypotension, dry mouth |
| Clonazepam | Benzodiazepine | 0.5 mg twice daily | Morning & evening | Dependence, sedation |
Dosing should be individualized; consult guidelines. Mayo ClinicCleveland Clinic
Dietary and Regenerative Supplements
Glucosamine sulfate – 1 500 mg/day; supports cartilage formation by supplying substrate for glycosaminoglycans.
Chondroitin sulfate – 1 200 mg/day; inhibits cartilage-degrading enzymes.
Omega-3 fatty acids – 1 000 mg/day; anti-inflammatory via COX and LOX pathway modulation.
Vitamin D₃ – 1 000 IU/day; promotes calcium absorption and bone health.
Calcium citrate – 1 000 mg/day; essential for bone mineralization.
Curcumin – 500 mg twice daily; downregulates NF-κB inflammatory signaling.
Type II collagen – 40 mg/day; may induce immune tolerance to joint collagen.
Methylsulfonylmethane (MSM) – 1 500 mg/day; may reduce oxidative stress in joints.
Vitamin C – 500 mg twice daily; cofactor in collagen synthesis.
Boron – 3 mg/day; supports bone metabolism and steroid hormone balance. KenhubScienceDirect
Surgical Options
Anterior cervical discectomy and fusion (ACDF) – removal of disc, fusion with graft.
Posterior cervical fusion – rods and screws posteriorly to stabilize.
Cervical laminectomy – decompress spinal cord by removing lamina.
Laminoplasty – hinge-opening of lamina to enlarge canal.
Foraminotomy – enlarge neural foramen to relieve nerve root pressure.
Total disc replacement – artificial disc insertion to maintain motion.
Corpectomy – removal of vertebral body and reconstruction.
Vertebral osteotomy – cutting bone to realign spine.
Occipitocervical fusion – fusion from occiput to upper cervical spine.
Posterior instrumentation with cage – restore disc height, stabilize. Mayo ClinicHome
Prevention Strategies
Maintain good posture
Use ergonomic workstations
Perform regular neck strengthening exercises
Practice neck flexibility/stretching
Avoid heavy lifting or use proper technique
Keep a healthy weight
Quit smoking
Warm up before sports
Use protective gear in high-impact activities
Schedule regular spinal check-ups if at risk Hospital for Special SurgeryCleveland Clinic
When to See a Doctor
Persistent or severe neck pain lasting > 2 weeks
Neurological deficits (weakness, numbness)
Balance or coordination issues
Loss of bladder/bowel control
Symptoms worsening despite conservative care
Significant trauma to the neck Cleveland ClinicPatient Care at NYU Langone Health
Frequently Asked Questions
What is a backward slip (retrolisthesis) at C6–C7?
It’s when C6 moves backward relative to C7, reducing canal space and potentially compressing nerves or the spinal cord Cleveland ClinicOHSU.How is it diagnosed?
By clinical exam and imaging (X-ray flexion/extension, MRI, CT) to assess alignment and neural compromise Mayo ClinicPatient Care at NYU Langone Health.Is it the same as cervical spondylosis?
No; spondylosis refers to degenerative changes, while retrolisthesis is actual backward displacement of a vertebra.Can it heal on its own?
Mild cases may stabilize with physical therapy and lifestyle measures, but bone slip rarely “reverses.”What activities worsen it?
Heavy lifting, repetitive hyperextension or flexion, and high-impact sports without proper conditioning.What conservative treatments work best?
A combination of physical therapy, traction, posture correction, and ergonomic adjustments often provides relief Hospital for Special Surgery.When is surgery necessary?
If neurological deficits, severe pain, or spinal cord compression persist despite months of conservative care.What are surgical risks?
Infection, bleeding, nerve injury, nonunion of fusion, adjacent segment disease Home.Can supplements help?
Supplements like glucosamine, omega-3, and vitamin D may support joint health but won’t reverse slip.How long is recovery after ACDF?
Most patients improve over 3–6 months, with fusion solidifying by 12 months Home.Is retrolisthesis painful in all cases?
No; many people have it incidentally on X-ray without symptoms.Does it affect life expectancy?
No; it’s a mechanical issue manageable with proper care.Can posture correction tools help?
Temporary bracing and ergonomic devices can reduce stress but should be combined with active therapy.Are nerve blocks useful?
Facet joint or epidural steroid injections can provide short-term relief of radicular pain.How often should I follow up?
Typically every 3–6 months during active treatment, then annually if stable.
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.
