Cervical spondylolisthesis occurs when one vertebra in the neck (cervical spine) slips forward or backward over the one below it. When this slip involves the fifth cervical vertebra (C5) moving over the sixth (C6), it’s called C5–C6 spondylolisthesis. Although less common than lumbar spondylolisthesis, it can cause neck pain, arm symptoms, and—even in severe cases—spinal cord compression. This in-depth, evidence-based guide covers everything you need to know about cervical spondylolisthesis at C5–C6, from anatomy and causes to treatments, surgeries, prevention, and frequently asked questions.
Anatomy of the C5–C6 Segment
Understanding normal C5–C6 anatomy helps explain how and why spondylolisthesis develops.
Structure & Location
Vertebral Bodies: C5 and C6 are two of seven small vertebrae that form the cervical spine. Each has a cylindrical body anteriorly and a vertebral arch posteriorly.
Intervertebral Disc: A fibrocartilaginous cushion between C5 and C6 absorbs shock and allows motion.
Facet Joints: Paired joints at the back connect C5’s inferior facets to C6’s superior facets, guiding movement.
Ligament Attachments (Origin/Insertion)
Anterior Longitudinal Ligament (ALL)
Origin: Occipital bone and C1 anterior tubercle
Insertion: Runs down front of vertebral bodies to T12; attaches along C5 and C6 bodies
Posterior Longitudinal Ligament (PLL)
Origin: Posterior C2 arch
Insertion: Runs inside spinal canal to C7, attaches to C5–C6 disc and bodies
Ligamentum Flavum
Origin/Insertion: Connects laminae of C5 and C6 arches, forming part of the vertebral canal’s roof
Muscles (Origin/Insertion)
Longus Colli
Origin: Bodies of C5–T3
Insertion: Anterior tubercles of C1–C3
Function: Flexes and stabilizes cervical spine
Semispinalis Cervicis
Origin: Transverse processes of T1–T6
Insertion: Spinous processes of C2–C5
Function: Extends and rotates neck
Blood Supply
Vertebral Arteries: Travel through transverse foramina of C1–C6, including C5–C6, supplying vertebrae and spinal cord.
Ascending Cervical Arteries: Branch from the thyrocervical trunk, supply muscles and ligaments around C5–C6.
Nerve Supply
Ventral Rami (C6 Nerve Root): Emerges between C5 and C6, carries motor and sensory fibers for arm movement and sensation.
Dorsal Rami: Innervate facet joints and paraspinal muscles at C5–C6.
Key Functions of C5–C6
Support: Bears weight of head and transmits load to thoracic spine.
Protection: Shields the spinal cord and nerve roots within the spinal canal.
Motion: Allows flexion/extension, rotation, and lateral bending.
Shock Absorption: Intervertebral disc cushions axial forces.
Muscle Attachment: Serves as anchor points for neck muscles and ligaments.
Neural Conduit: Provides passage for nerve roots exiting to the arms.
Types of Cervical Spondylolisthesis
Anterolisthesis: Forward slip of C5 over C6 (most common).
Retrolisthesis: Backward slip of C5 on C6.
Lateral Spondylolisthesis: Sideways displacement.
Rotatory Spondylolisthesis: Twisting displacement.
Isthmic: Slip due to a defect in the pars interarticularis (rare in cervical spine).
Degenerative: Slip from arthritis and disc wear.
Traumatic: Acute slip after injury.
Pathological: Slip due to bone disease or tumor.
Dysplastic (Congenital): Slip from vertebral malformation since birth.
Postsurgical (Iatrogenic): Slip after cervical spine surgery.
Causes
Degenerative Disc Disease: Disc height loss and instability.
Facet Joint Arthritis: Worn joints allow slipping.
Trauma: Fractures/luxations in car accidents or falls.
Congenital Malformation: Abnormal vertebral shape or alignment.
Osteoporosis: Weak bones prone to collapse.
Spondylolysis: Defect in the vertebral arch.
Post-surgical Instability: After laminectomy or discectomy.
Infection (e.g., Osteomyelitis): Bone destruction leads to slip.
Tumor (Primary or Metastatic): Bone erosion at C5–C6.
Rheumatoid Arthritis: Ligament laxity and bone erosion.
Ankylosing Spondylitis: Abnormal ossification alters alignment.
Metabolic Bone Disease: Paget’s disease, hyperparathyroidism.
Spinal Deformities: Scoliosis, kyphosis affecting cervical alignment.
Ligamentous Laxity: Ehlers–Danlos, Marfan syndrome.
Neuromuscular Conditions: Muscular dystrophy, causing imbalance.
Repeated Microtrauma: Heavy lifting, contact sports.
Degenerative Scoliosis: Alters force distribution.
Obesity: Extra load on cervical segments.
Smoking: Impairs disc nutrition and healing.
Poor Posture: “Tech neck” from prolonged flexion.
Symptoms
Neck Pain: Dull ache or sharp pain at C5–C6 level.
Stiffness: Limited neck motion.
Radiating Arm Pain: Follows C6 nerve root distribution.
Numbness/Tingling: In thumb and index finger.
Arm Weakness: Especially wrist extension.
Muscle Spasms: Paraspinal tightness.
Headaches: Originating from neck (cervicogenic).
Loss of Grip Strength: Difficulty holding objects.
Clumsiness: Fine motor issues in hand.
Gait Disturbance: If spinal cord compression occurs.
Hyperreflexia: Exaggerated reflexes in arms or legs.
Positive Hoffmann’s Sign: Upper motor neuron sign.
Lhermitte’s Sign: Electric sensation down spine on neck flexion.
Balance Problems: Unsteady walking.
Bowel/Bladder Changes: Severe cord compression.
Pain with Movement: Worse on flexion/extension.
Fatigue: From chronic pain.
Sensory Loss: Reduced pinprick or light touch.
Atrophy: Muscle wasting in hand or forearm.
Neck Instability Sensation: Feeling of slipping or giving way.
Diagnostic Tests
Plain X-rays (Lateral View): Measures vertebral slip percentage.
Flexion-Extension X-rays: Detects dynamic instability.
Computed Tomography (CT): Detailed bone anatomy.
Magnetic Resonance Imaging (MRI): Disc, nerve, and cord evaluation.
CT Myelogram: CT with intrathecal contrast for canal narrowing.
Discography: Injects contrast into disc to identify pain source.
Bone Scan: Detects infection or tumor activity.
Electromyography (EMG): Assesses nerve root function.
Nerve Conduction Study: Measures nerve signal speed.
Somatosensory Evoked Potentials: Tests spinal cord pathways.
Digital Motion X-ray: Real-time imaging of instability.
Dynamic MRI: Images under movement.
Ultrasound: Evaluates soft tissues (rarely used).
Blood Tests: CBC, ESR, CRP for inflammation or infection.
DEXA Scan: Bone density for osteoporosis.
Fluoroscopy-Guided Injection: Diagnostic pain relief.
Spurling’s Test: Neck compression reproduces radicular pain.
Valleix Points Palpation: Local tenderness along nerve.
Neck Disability Index (NDI): Patient-reported function.
Visual Analog Scale (VAS): Pain intensity rating.
Non-Pharmacological Treatments
Each description explains the method and how it eases symptoms.
Physical Therapy: Exercises to strengthen stabilizers and improve posture.
Cervical Collar (Soft): Limits motion for healing.
Cervical Traction: Gentle pulling to decompress nerves and discs.
Heat Therapy: Increases blood flow and relaxes muscles.
Cold Therapy: Reduces inflammation and numbs pain.
Ultrasound Therapy: Deep heating to promote tissue healing.
Transcutaneous Electrical Nerve Stimulation (TENS): Electrical pulses block pain signals.
Acupuncture: Needle stimulation modulates pain pathways.
Chiropractic Manipulation: Spinal adjustments to restore alignment—use with caution.
Massage Therapy: Loosens tight muscles and improves circulation.
Posture Education: Ergonomic training for sitting, standing, and sleeping.
Ergonomic Workspace: Proper monitor height, chair support, and keyboard placement.
Spinal Stabilization Exercises: Focus on deep neck flexors and scapular muscles.
Core Strengthening: Improves overall posture and spine support.
Yoga: Flexibility and gentle strengthening, with neck-safe modifications.
Pilates: Focus on core control and spinal alignment.
Aquatic Therapy: Exercising in water reduces load on spine.
Tai Chi: Slow movements improve balance and posture.
Traction Table Therapy: Mechanical traction under supervision.
Cervical Pillow: Supports natural neck curve during sleep.
Kinesio Taping: Provides proprioceptive feedback and support.
Education on Activity Modification: Avoiding aggravating movements.
Cryotherapy: Localized cold packs after activity.
Thermotherapy: Hot packs before exercise to loosen tissues.
Low-Level Laser Therapy: May reduce pain and inflammation.
Dry Needling: Targets trigger points in neck muscles.
Mindfulness Meditation: Lowers pain perception by stress reduction.
Cognitive Behavioral Therapy (CBT): Helps manage chronic pain.
Nutrition Counseling & Weight Management: Reducing load on joints.
Postural Taping: Reminds correct neck posture throughout the day.
Pharmacological Treatments
| Drug | Class | Typical Dosage | Timing | Common Side Effects |
|---|---|---|---|---|
| Ibuprofen | NSAID | 200–400 mg every 4–6 h (max 1 200 mg/day) | With meals | GI upset, headache, dizziness |
| Naproxen | NSAID | 250–500 mg twice daily | Morning & evening | GI bleeding, fluid retention |
| Diclofenac | NSAID | 50 mg three times daily | With food | Liver enzyme elevation, GI pain |
| Celecoxib | COX-2 inhibitor | 100–200 mg once or twice daily | With or without food | Edema, hypertension |
| Aspirin | NSAID/Antiplatelet | 325–650 mg every 4–6 h | With food | GI bleeding, tinnitus |
| Ketorolac | NSAID | 10 mg every 4–6 h (max 40 mg/day) | Short term only | Kidney impairment, GI ulceration |
| Acetaminophen | Analgesic | 325–650 mg every 4–6 h (max 3 000 mg/day) | Any time | Liver toxicity at high doses |
| Cyclobenzaprine | Muscle relaxant | 5–10 mg three times daily | Bedtime if drowsy | Drowsiness, dry mouth |
| Baclofen | Muscle relaxant | 5 mg three times daily, titrate to 20–80 mg/day | Morning/midday/night | Weakness, fatigue |
| Gabapentin | Neuropathic analgesic | 300–900 mg at bedtime, titrate to 900–3 600 mg/day | Bedtime | Dizziness, sedation |
| Pregabalin | Neuropathic analgesic | 75 mg twice daily, titrate to 300 mg/day | Morning & evening | Weight gain, peripheral edema |
| Amitriptyline | Tricyclic antidepressant | 10–25 mg at bedtime | Bedtime | Dry mouth, sedation |
| Duloxetine | SNRI | 30–60 mg once daily | Morning | Nausea, insomnia |
| Tramadol | Opioid analgesic | 50–100 mg every 4–6 h (max 400 mg/day) | As needed | Constipation, dizziness |
| Prednisone | Oral corticosteroid | 5–10 mg daily | Morning | Weight gain, osteoporosis |
| Methylprednisolone dose pack | Oral corticosteroid | Tapered doses over 6 days | Morning | Mood changes, hyperglycemia |
| Epidural steroid injection | Corticosteroid | Triamcinolone 40 mg per injection | Under fluoroscopy | Local soreness, rare infection |
| Hyaluronic acid injection | Viscosupplement | 20 mg per injection once weekly ×3 | In-office procedure | Injection site pain |
| Topical NSAID gel | NSAID | Apply 2–4 g to neck area up to 4×/day | As needed | Local irritation |
| Lidocaine patch | Local anesthetic | 5% patch for up to 12 h/day | Applied to painful area | Skin redness |
Dietary Supplements
| Supplement | Dosage | Primary Function | Mechanism of Action |
|---|---|---|---|
| Glucosamine | 1 500 mg daily | Joint health | Promotes cartilage repair, reduces inflammation |
| Chondroitin | 1 200 mg daily | Disc and joint support | Inhibits degradative enzymes in cartilage |
| Omega-3 (Fish oil) | 1 000–3 000 mg EPA/DHA daily | Anti-inflammatory | Produces anti-inflammatory eicosanoids |
| Vitamin D₃ | 1 000–2 000 IU daily | Bone health | Enhances calcium absorption |
| Calcium | 1 000 mg daily | Bone strength | Provides mineral for bone matrix |
| Curcumin | 500–1 000 mg twice daily | Anti-inflammatory | Inhibits NF-κB pathway |
| Collagen Type II | 40 mg daily | Disc matrix support | Supplies amino acids for collagen synthesis |
| Boswellia serrata | 300–500 mg three times daily | Pain relief | Inhibits 5-lipoxygenase to reduce leukotrienes |
| SAMe | 400–800 mg daily | Analgesic | Increases synovial fluid proteoglycan synthesis |
| Magnesium citrate | 200–400 mg daily | Muscle relaxation | Regulates calcium handling in muscle cells |
Regenerative & Advanced Drugs
| Therapy | Dosage/Method | Functional Goal | Mechanism |
|---|---|---|---|
| Alendronate | 70 mg once weekly orally | Inhibit bone resorption | Bisphosphonate binds hydroxyapatite, inhibits osteoclasts |
| Risedronate | 35 mg once weekly orally | Increase bone density | Same as alendronate |
| Zoledronic Acid | 5 mg IV once yearly | Strengthen vertebrae | Potent bisphosphonate effect |
| Teriparatide | 20 µg SC daily | Promote bone formation | PTH analog stimulates osteoblasts |
| Denosumab | 60 mg SC every 6 months | Reduce bone turnover | RANKL inhibitor blocks osteoclast formation |
| BMP-2 (Bone Morphogenetic Protein-2) | Local application during surgery | Enhance fusion | Stimulates bone growth at graft site |
| Hyaluronic Acid (Viscosupplement) | 20 mg injection weekly ×3 | Lubricate facet joints | Restores synovial fluid viscosity |
| Platelet-Rich Plasma (PRP) | 3–5 mL injection under image guidance | Promote tissue healing | Delivers growth factors from platelets |
| Mesenchymal Stem Cells | 1–10 million cells injection | Regenerate disc nucleus | Differentiate into chondrocytes, secrete cytokines |
| Exosomes | Injected with MSC therapy | Enhance cellular communication | Vesicles carry mRNA/proteins to promote repair |
Surgical Options
Anterior Cervical Discectomy & Fusion (ACDF)
Remove disc, insert bone graft and plate for fusion.
Anterior Cervical Corpectomy & Fusion
Remove vertebral body plus discs above/below, place graft/plate.
Posterior Cervical Laminectomy
Remove lamina to decompress spinal cord. Often combined with fusion.
Posterior Cervical Fusion
Rods and screws fixate C5–C6 to promote fusion.
Posterior Foraminotomy
Widen nerve exit zone to relieve radiculopathy.
Cervical Disc Arthroplasty
Replace disc with artificial device to preserve motion.
Laminoplasty
Reconstruct lamina to expand spinal canal while preserving bone.
Posterior Dynamic Stabilization
Flexible instrumentation allowing limited motion.
Minimally Invasive Endoscopic Decompression
Small incisions, tubular retractors to remove compressive tissue.
Combined Anterior–Posterior Approach
Both front and back surgery in same session for severe instability.
Preventive Strategies
Maintain Good Posture: Keep head aligned over shoulders.
Regular Neck Exercises: Strengthen deep neck flexors.
Ergonomic Workspace: Monitor at eye level, supportive chair.
Use Supportive Pillow: Keeps cervical spine neutral during sleep.
Lift Safely: Bend knees, keep back straight.
Healthy Weight: Reduces load on spine.
Quit Smoking: Improves disc nutrition and healing.
Balanced Diet: Adequate calcium, vitamin D, protein.
Stay Active: Low-impact cardio like walking or swimming.
Avoid Repetitive Strain: Take breaks from phone/computer flexion.
When to See a Doctor
Red-Flag Symptoms: Sudden arm weakness, loss of bladder/bowel control, severe gait disturbance.
Persistent Pain: Neck or arm pain lasting >6 weeks despite home care.
Neurological Signs: Numbness, tingling, or reflex changes in arms.
Failed Conservative Care: No improvement after 8–12 weeks of physical therapy and medications.
Progressive Symptoms: Worsening pain or neurological deficits.
Frequently Asked Questions
What causes my C5–C6 vertebra to slip?
Degeneration of the disc and facet joints often weakens spinal stability, allowing C5 to move forward over C6.Can neck spondylolisthesis heal on its own?
Mild slips may stabilize with rest, physical therapy, and posture correction—true bone fusion rarely occurs without surgery.Will spondylolisthesis get worse over time?
It can progress, especially with ongoing degeneration or repetitive strain; early intervention slows progression.Is surgery always needed?
No—most people improve with non-surgical care. Surgery is reserved for severe pain, neurological problems, or instability.How long does recovery take after ACDF?
Bone fusion takes 3–6 months; many patients return to normal activities within 6–12 weeks.Are cervical collars effective?
Short-term use can reduce motion and pain, but long-term use weakens neck muscles.What exercises should I avoid?
Heavy overhead lifting, deep neck extension, or high-impact sports until cleared by a therapist.Can I drive with cervical spondylolisthesis?
Avoid driving if pain limits motion or requires narcotic pain medicines.Will injections cure my slip?
Steroid or PRP injections relieve inflammation and pain but don’t correct vertebral alignment.Is regenerative therapy safe?
PRP and stem cell injections show promise but remain somewhat experimental for cervical spine.How do I sleep comfortably?
Use a cervical pillow or rolled towel under the neck and sleep on your back when possible.Can supplements help?
Glucosamine, chondroitin, and anti-inflammatory botanicals may ease pain but won’t reverse slip.What role does weight play?
Extra body weight increases spinal load, accelerating degeneration and instability.When is physical therapy too painful?
Therapists can modify exercises if pain flares; communicate openly to avoid harm.Can spondylolisthesis cause headaches?
Yes—joint irritation at C5–C6 can refer pain upward, causing tension-type or cervicogenic headaches.
C5–C6 cervical spondylolisthesis is a complex condition blending anatomical changes, mechanical instability, and nerve compression. A clear understanding of its anatomy, causes, and presentation guides effective management—often starting with non-surgical care and reserving surgery for advanced cases. By combining lifestyle changes, targeted therapies, and, when necessary, surgical interventions, most people regain function, relieve pain, and maintain a healthy, active life. Remember, early diagnosis and personalized treatment plans are key to preventing progression and optimizing outcomes.
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.
