Cervical Anterolisthesis at C4 over C5

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 anterolisthesis at C4 over C5 is a spinal condition in which the fourth cervical vertebra (C4) slips forward relative to the fifth cervical vertebra (C5). This forward displacement can narrow the spinal canal or neural foramina, leading to neck pain, arm weakness, or sensory changes. Anterolisthesis is one type of spondylolisthesis, with the reverse slippage termed retrolisthesis.Medical News TodayCedars-Sinai

Anatomy of the C4–C5 Motion Segment

  1. Structure & Location
    The cervical spine consists of seven vertebrae (C1–C7). C4 is located in the middle of the neck, between C3 above and C5 below. Each vertebra has a drum-shaped body in front, paired facet joints at the back, and a central spinal canal for the spinal cord. Cedars-Sinai

  2. Origin & Insertion (Articulations)

    • Superior articulation: The inferior facet joints of C3 lock into the superior facets of C4.

    • Inferior articulation: The superior facets of C5 articulate with the inferior facets of C4.

    • Disc: The intervertebral disc between C4 and C5 “inserts” into the endplates of each vertebral body, allowing shock absorption and flexibility. U of U Health Medicine

  3. Blood Supply
    The vertebral arteries ascend through the transverse foramina of C6 to C1, sending small branches (anterior and posterior radicular arteries) to nourish the vertebral bodies, facet joints, and spinal cord at each level. U of U Health Medicine

  4. Nerve Supply

    • Sinuvertebral (recurrent meningeal) nerves supply the outer annulus fibrosus of the disc and the dorsal elements (ligaments, facet capsules).

    • Dorsal root ganglia at C5 contribute sensory fibers, while ventral roots carry motor fibers to the neck muscles. PubMed

  5. Key Functions

    1. Load bearing: Supports head weight.

    2. Motion: Allows flexion, extension, lateral bending, and rotation.

    3. Protection: Shields the spinal cord and nerve roots.

    4. Shock absorption: Disc and facets distribute forces.

    5. Muscle attachment: Offers surfaces for neck muscle origins and insertions.

    6. Joint guidance: Facet orientation guides smooth neck movements. HealthgradesU of U Health Medicine

Types of Cervical Anterolisthesis (Grades)

  • Grade I (mild): 0–25% slippage

  • Grade II (moderate): 25–50%

  • Grade III (severe): 50–75%

  • Grade IV (very severe): 75–100%

  1. By Severity (Meyerding Grades)

    • Grade I: <25% slippage

    • Grade II: 25–50%

    • Grade III: 50–75%

    • Grade IV: 75–100%

  2. By Duration

    • Acute: sudden, often from trauma.

    • Chronic: develops slowly, often from degeneration.

  3. By Cause

    • Degenerative: wear and tear.

    • Traumatic: fracture or ligament tear.

    • Pathologic: tumor, infection, or congenital.

Grades reflect the percentage of the vertebral body width that has slipped forward. Higher grades carry greater risk of neurological compromise. Healthgrades

Causes

  1. Degenerative disc disease

  2. Facet joint osteoarthritis

  3. Traumatic fracture–dislocation

  4. Congenital malformation of facets

  5. High-impact sports or accidents

  6. Whiplash injuries

  7. Rheumatoid arthritis

  8. Ankylosing spondylitis

  9. Spinal tumors eroding bone

  10. Infections (e.g., osteomyelitis)

  11. Osteoporosis weakening bone

  12. Post-surgical instability

  13. Spondylolysis (pars defect)

  14. Connective tissue disorders (e.g., Ehlers–Danlos)

  15. Metabolic bone disease

  16. Long-term steroid use

  17. Obesity increasing spinal load

  18. Repetitive neck extension activities

  19. Ligamentous laxity

  20. Idiopathic (unknown)

Bulleted for clarity, based on degenerative, traumatic, congenital, inflammatory, and metabolic factors. HealthgradesPubMed

Symptoms

  1. Neck pain and stiffness

  2. Radiating arm pain (radiculopathy)

  3. Numbness or tingling in arms/hands

  4. Muscle weakness in upper limbs

  5. Headaches at base of skull

  6. Reduced neck motion

  7. Grinding or popping during movement

  8. Balance difficulties

  9. Gait disturbances

  10. Loss of fine motor skills

  11. Muscle spasms

  12. Shoulder pain

  13. Dizziness (cervicogenic)

  14. Sensory changes over shoulder blade

  15. In severe cases, bowel/bladder dysfunction

  16. Sleep disturbances due to pain

  17. Fatigue from chronic discomfort

  18. Muscle atrophy in advanced paresis

  19. Torticollis (head tilt)

  20. Difficulty concentrating due to chronic pain

Symptoms range from mild neck discomfort to serious neurological deficits. Medical News TodayVerywell Health

Diagnostic Tests

  1. Plain X-rays (AP, lateral, flexion/extension views)

  2. MRI of cervical spine

  3. CT scan with bone windows

  4. CT myelogram

  5. EMG/Nerve conduction studies

  6. Bone density (DEXA)

  7. Blood tests (inflammatory markers, infection workup)

  8. Dynamic fluoroscopy

  9. Discography (rarely)

  10. Ultrasound of paraspinal muscles

  11. Spinal canal measurement via imaging

  12. Vertebral artery Doppler ultrasound

  13. Neurological exam (reflexes, strength, sensation)

  14. Provocative maneuvers (Spurling’s test)

  15. Gait analysis

  16. Balance and coordination tests

  17. Functional questionnaires (NDI, VAS)

  18. CT-based finite element analysis (research)

  19. Kinematic MRI (motion assessment)

  20. Psychosocial evaluation

Combining imaging, electrophysiology, and clinical exams ensures accurate grading and treatment planning. PubMedHealthgrades

Non-Pharmacological Treatments

  1. Physical therapy – core and neck strengthening

  2. Cervical traction (mechanical/manual)

  3. Postural education

  4. Ergonomic assessments

  5. Heat/cold therapy

  6. Ultrasound therapy

  7. Electrical stimulation (TENS)

  8. Acupuncture

  9. Chiropractic manipulation (selected cases)

  10. Massage therapy

  11. Yoga and Pilates

  12. Cervical collars (soft/hard)

  13. Activity modification

  14. Weight management

  15. Smoking cessation

  16. Mindfulness meditation

  17. Biofeedback training

  18. Functional bracing

  19. Hydrotherapy

  20. Dry needling

  21. Myofascial release

  22. Kinesiology taping

  23. Occupational therapy

  24. Cognitive-behavioral therapy

  25. Pilates ball exercises

  26. Spinal decompression tables

  27. Proprioceptive training

  28. Gait training

  29. Aquatic therapy

  30. Education programs on spine health

Emphasis on active rehabilitation, posture correction, and lifestyle changes. HealthgradesShanti

Drugs

Drug CategoryExample AgentIndication
NSAIDsIbuprofenPain, inflammation
COX-2 inhibitorsCelecoxibChronic pain
Muscle relaxantsCyclobenzaprineSpasm
Neuropathic agentsGabapentinRadicular pain
Oral corticosteroidsPrednisoneAcute inflammation
Opioids (short-term)TramadolSevere pain
Antidepressants (TCAs/SNRIs)AmitriptylineChronic neuropathic pain
Topical analgesicsLidocaine patchesLocalized pain
Epidural injectionsMethylprednisoloneRadiculopathy
Vitamin supplementsVitamin D, CalciumBone health
BisphosphonatesAlendronateOsteoporosis
CalcitoninSalmon calcitoninBone pain
DenosumabDenosumabOsteoporosis
Anabolic agentsTeriparatideSevere osteoporosis
Disease-modifying antirheumatic drugs (DMARDs)MethotrexateInflammatory arthritis
BiologicsEtanerceptRA-related instability
Antibiotics (if infection)IV vancomycinSpinal osteomyelitis
Anticoagulants (post-op)EnoxaparinThromboprophylaxis
Gastroprotective agentsPantoprazoleNSAID-induced gastritis prevention
AnticonvulsantsCarbamazepineNeuropathic pain

Medication choice depends on pain severity, neurological involvement, and underlying cause. Medical News TodayVerywell Health

Surgical Options

  1. Anterior cervical discectomy and fusion (ACDF)

  2. Anterior cervical corpectomy and fusion

  3. Posterior cervical laminectomy and fusion

  4. Posterior cervical laminoplasty

  5. Cervical disc replacement (arthroplasty)

  6. Foraminotomy (posterior)

  7. Posterior fixation with lateral mass screws

  8. Minimally invasive tubular decompression

  9. Combined anterior–posterior approaches

  10. Vertebral body tethering (experimental)

Surgery is considered for progressive neurological deficits, intractable pain, or high-grade slippage. PubMedPubMed

Preventive Strategies

  1. Maintain healthy posture

  2. Regular neck and upper back exercises

  3. Ergonomic workstation setup

  4. Avoid repetitive overhead activities

  5. Use proper lifting techniques

  6. Wear protective gear in sports

  7. Maintain healthy weight

  8. Quit smoking

  9. Adequate calcium and vitamin D intake

  10. Regular bone density screenings

Prevention focuses on spinal health, nutrition, and avoiding high-risk activities. HealthgradesU of U Health Medicine

When to See a Doctor

  • Persistent or worsening neck pain despite rest and home measures.

  • Radiating arm pain with numbness or weakness.

  • Loss of bladder or bowel control.

  • Gait instability or falls.

  • Sudden severe neck injury or high-impact trauma.

Early medical evaluation prevents progression and irreversible nerve damage. Verywell HealthPubMed

 Frequently Asked Questions

  1. What causes C4 over C5 anterolisthesis?
    Degeneration, trauma, congenital defects, or systemic disease can weaken spinal structures and lead to forward slippage. Healthgrades

  2. How is it diagnosed?
    X-rays with flexion/extension views confirm slippage; MRI and CT assess neural compression. PubMed

  3. Can physical therapy help?
    Yes—targeted exercises improve strength, posture, and pain. Shanti

  4. Is surgery always necessary?
    No—mild cases often respond to conservative treatment. Surgery is reserved for neurological deficits or high-grade slips. PubMed

  5. What is the recovery time post-surgery?
    Typically 3–6 months for fusion procedures; faster for minimally invasive techniques. PubMed

  6. Are there risks with cervical collars?
    Prolonged use can weaken neck muscles; use under guidance. Shanti

  7. Can this condition lead to paralysis?
    Severe slippage with untreated spinal cord compression can risk permanent deficits. PubMed

  8. Is anterolisthesis reversible?
    Non-surgical treatments manage symptoms but do not reverse slippage; surgical fusion stabilizes alignment. Healthgrades

  9. How common is C4–C5 involvement?
    C4–C5 is the second most common cervical level for degenerative slippage, after C5–C6. U of U Health Medicine

  10. Can I exercise with this condition?
    Low-impact activities (swimming, walking) are safe; avoid contact sports until cleared. Shanti

  11. What medications relieve symptoms?
    NSAIDs, muscle relaxants, and neuropathic agents are commonly used. Medical News Today

  12. How to prevent progression?
    Postural correction, occupational adjustments, and weight control help slow degeneration. Healthgrades

  13. What is the role of injections?
    Epidural steroid injections reduce inflammation and radicular pain temporarily. Verywell Health

  14. Are there alternative therapies?
    Acupuncture, massage, and chiropractic care may provide symptom relief in mild cases. Shanti

  15. When should I seek urgent care?
    Sudden loss of limb function, severe unremitting pain, or bowel/bladder dysfunction warrant emergency evaluation. PubMed

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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