Cervical anterolisthesis at C5–C6 happens when the C5 vertebra slips forward over C6, disrupting normal alignment in the neck. This forward shift can pinch nerves or compress the spinal cord, causing pain, stiffness, or weakness in the shoulders, arms, or hands. RadiopaediaMedical News Today
Anatomy of the C5–C6 Segment
Structure & Location
Vertebral Bodies & Facets: C5 sits just above C6 in the middle of the neck. Each has a drum-shaped body up front and paired facet joints at the back, guiding movement and bearing load.
Transverse Foramina: Tiny holes on each side of C5 and C6 let the vertebral arteries pass to supply the brain. TeachMeAnatomy
Muscle Origins & Insertions
Several neck muscles anchor on C5–C6, stabilizing and moving your head:
Scalenes: Originate on transverse processes of C3–C6; insert on ribs 1–2 to bend and rotate the neck.
Longus Colli: Originates on bodies of T1–C5; inserts on anterior C1–C3 to flex the neck and maintain posture. Wikipedia
Blood Supply
Vertebral Arteries: Branch from the subclavian arteries, ascend through transverse foramina of C1–C6 and feed the upper spinal cord and brainstem.
Radicular Arteries: Small branches from vertebral and ascending cervical arteries supply the vertebral bodies and nearby ligaments. Kenhub
Nerve Supply
C5 & C6 Nerve Roots: Exit above their respective vertebrae through intervertebral foramina, join to form the upper trunk of the brachial plexus, and send motor signals to shoulder and arm muscles. Sensory fibers relay touch and pain from the outer shoulder and lateral arm. NCBI
Key Functions
Head Support: Bears weight of the skull.
Flexion/Extension: Allows nodding and looking up/down.
Rotation: Turns head side to side.
Lateral Bending: Tilts head toward shoulders.
Protection: Shields the spinal cord passing through the vertebral canal.
Load Transmission: Passes forces between head and torso. Cleveland Clinic
Types of Cervical Anterolisthesis
Degenerative: Age-related wear of facets and discs.
Isthmic: Fatigue fracture (spondylolysis) of the neural arch.
Traumatic: High-force injury fracturing posterior elements.
Pathologic: Bone weakened by infection or cancer.
Post-surgical (Iatrogenic): Following cervical spine surgery. Wikipedia
Causes
Osteoarthritis of facet joints
Disc degeneration
Spondylolysis (pars defect)
Whiplash or sudden hyperextension
Fractures of vertebral arch
Rheumatoid arthritis
Osteoporosis
Infection (osteomyelitis)
Spinal tumors
Congenital malformations
Post-surgical instability
Repetitive overhead activities
Poor posture over time
Ligament laxity (e.g., Ehlers-Danlos)
Hip or lower-back compensation patterns
High-impact sports injuries
Degenerative scoliosis
Cervical spine injections complications
Rheumatic fever (rare)
Metastatic cancer weakening bone
Symptoms
Neck pain worsening with movement
Stiffness in the neck
Shoulder ache or tightness
Radiating pain down the arm
Tingling or “pins and needles” in fingers
Muscle weakness in arms or hands
Headaches at the base of skull
Decreased neck range of motion
Grinding or crunching sounds
Feeling of instability or giving way
Numbness in the lateral arm
Reflex changes (e.g., brisk biceps reflex)
Difficulty with fine motor skills
Balance problems if cord compressed
Gait disturbances in severe cases
Dizziness or lightheadedness
Burning sensation in shoulder blade
Fatigue from holding head upright
Emotional distress from chronic pain
Sleep disturbance due to discomfort
Diagnostic Tests
Plain X-rays (neutral, flexion, extension)
MRI scan for discs and cord
CT scan for bone detail
Dynamic radiographs to assess instability
Electromyography (EMG) for nerve function
Nerve conduction studies
Myelography with CT if MRI contraindicated
Bone scan for infection or tumor
Discography to pinpoint disc pain
Ultrasound for soft-tissue evaluation
Flexion-extension MRI
Tilt table test for dizziness
Cervical traction test
Local anesthetic nerve blocks
Blood tests (inflammatory markers)
Dual-energy CT for bone density
Positional MRI
Somatosensory evoked potentials
Kinematic MRI
Psychosocial assessment for pain impact
Non-Pharmacological Treatments
Cervical traction exercises
Posture re-education
Cervical stabilization exercises
Manual therapy (massage)
Heat therapy
Cold packs
Ultrasound therapy
TENS (electrical stimulation)
Acupuncture
Dry needling
Cervical collar (short-term)
Ergonomic workstation setup
Yoga stretches for neck
Pilates for core support
Tai chi for balance
Alexander technique
Biofeedback for muscle control
Mindfulness meditation
Stress-management training
Cervical mobilization by physio
Myofascial release
Kinesio taping
Aquatic therapy
Cervical posture taping
Sleep-posture modification
Weighted head harness exercises
Balance and proprioception drills
Neural gliding exercises
Dry heat packs with infrared
Laser therapy
Drugs & Dosages
| Drug (Class) | Typical Adult Dosage | Notes |
|---|---|---|
| Ibuprofen (NSAID) | 400–800 mg PO every 6–8 h as needed | Max 3,200 mg/day |
| Naproxen (NSAID) | 250–500 mg PO twice daily | Max 1,000 mg/day |
| Diclofenac (NSAID) | 50 mg PO three times daily | Use lowest effective dose |
| Celecoxib (COX-2 inhibitor) | 200 mg PO once or twice daily | Useful if GI risk |
| Ketorolac (NSAID) | 10 mg IM/IV every 4–6 h (max 40 mg/day) | Short-term only (<5 days) |
| Acetaminophen (Analgesic) | 500–1,000 mg PO every 6 h | Max 4 g/day |
| Methocarbamol (Muscle relax.) | 1,500 mg PO four times daily | Monitor sedation |
| Cyclobenzaprine (Muscle rel.) | 5–10 mg PO three times daily | Short-term use only |
| Tizanidine (Muscle relax.) | 2–4 mg PO every 6–8 h | Watch for hypotension |
| Gabapentin (Neuropathic) | 300 mg PO at bedtime; titrate to 900–1,800 mg/day | For nerve-related pain |
| Pregabalin (Neuropathic) | 75 mg PO twice daily; may increase | Adjust in renal impairment |
| Amitriptyline (TCA) | 10–25 mg PO at bedtime | Useful for chronic pain; monitor anticholinergic |
| Duloxetine (SNRI) | 30 mg PO once daily | May raise to 60 mg daily |
| Tramadol (Opioid) | 50–100 mg PO every 4–6 h as needed | Risk of dependence; limit duration |
| Morphine (Opioid) | 2–5 mg IV every 3–4 h as needed | Reserved for severe cases |
| Hydromorphone (Opioid) | 0.5–1 mg IV every 2–3 h | Use cautiously |
| Prednisone (Steroid) | 5–60 mg PO daily tapering over 1–2 weeks | Short courses for severe inflammation |
| Methylprednisolone (Steroid) | 40–60 mg PO daily taper | Follows burst-dose protocols |
| Baclofen (Muscle relax.) | 5 mg PO three times daily, titrate to 80 mg/day | Watch for sedation |
| Lidocaine patch 5% | Apply 1–3 patches topically for 12 h/day | For local pain |
Surgical Options
Anterior Cervical Discectomy & Fusion (ACDF): Remove disc, insert bone graft, plate fixation.
Cervical Disc Replacement: Insert artificial disc to maintain motion.
Posterior Cervical Fusion: Screws and rods stabilize slipped segment.
Laminectomy: Remove back of vertebra to decompress spinal cord.
Foraminotomy: Widen nerve exit hole to relieve pinched nerve.
Corpectomy: Remove part of vertebral body and replace with graft.
Posterior Cervical Laminoplasty: Reshape lamina to expand canal.
Minimally Invasive Posterior Fusion: Muscle-sparing small incisions.
Interspinous Process Devices: Small implants limit extension.
Dynamic Stabilization Systems: Flexible rods to support motion.
Prevention Strategies
Maintain good posture at desk and while driving.
Use ergonomic chairs and pillows.
Perform neck-strengthening and flexibility exercises.
Avoid excessive overhead lifting.
Take regular breaks during prolonged sitting.
Sleep on a supportive pillow that keeps neck aligned.
Warm up before sports or heavy activity.
Use head-support harnesses when rehabilitating.
Stay active with low-impact exercise (walking, swimming).
Maintain healthy weight to reduce spinal load.
When to See a Doctor
Seek medical care if you experience:
Severe or worsening neck pain
Radiating arm weakness or numbness
Difficulty walking or balance issues
Loss of bladder or bowel control (medical emergency)
Pain that isn’t relieved by rest or simple treatments
Frequently Asked Questions
| Q | A |
|---|---|
| 1. What grade is mild C5–C6 anterolisthesis? | Grade I (0–25% forward slip). |
| 2. Can physical therapy fix anterolisthesis? | It can strengthen stabilizers and relieve symptoms but won’t reverse slippage. |
| 3. Is surgery always needed? | No—most cases respond to conservative care unless there’s severe spinal cord compression. |
| 4. How long for recovery after ACDF? | Typically 3–6 months to fuse fully; many resume light activity within 4–6 weeks. |
| 5. Does an artificial disc last? | Modern discs can last 10–20 years or more but may wear out eventually, requiring revision. |
| 6. Can I drive with C5–C6 anterolisthesis? | Yes if pain and mobility allow; otherwise, limit long trips until better controlled. |
| 7. Are cervical collars helpful? | Short-term use may relieve pain, but prolonged use can weaken neck muscles. |
| 8. Will weight loss help? | Losing excess weight reduces load on the cervical spine, easing pain and slowing degeneration. |
| 9. What home remedies work best? | Heat, gentle traction over a doorway, and posture correction often help mild cases. |
| 10. How to prevent recurrence after surgery? | Follow doctor’s rehab plan, avoid heavy lifting, maintain neck exercises. |
| 11. Can anterolisthesis cause headaches? | Yes—tension at C5–C6 can refer pain to the back of the head. |
| 12. Is cervical anterolisthesis genetic? | There’s no direct inheritance, but congenital spine abnormalities can increase risk. |
| 13. Does smoking affect recovery? | Yes—smoking slows bone healing and fusion after surgery. |
| 14. How to sleep comfortably with neck slippage? | Sleep supine with a cervical pillow; avoid stomach sleeping. |
| 15. When is anterolisthesis life-threatening? | Rarely; only if severe spinal cord compression causes paralysis or loss of autonomic control. |
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.
