A backward slip of C5 over C6, medically called retrolisthesis, occurs when the fifth cervical vertebra shifts backwards relative to the sixth. This misalignment can narrow spinal canals, pinch nerves, and lead to neck pain, stiffness, and other symptoms. Retrolisthesis is graded by how far the vertebra has slipped—mild (grade I), moderate (grade II), severe (grade III), or complete displacement (grade IV).
Anatomy of the C5–C6 Motion Segment
The C5–C6 motion segment is located in the lower part of the cervical spine, just above the C7 vertebra. It consists of two vertebral bodies (C5 and C6), an intervertebral disc between them, paired facet (zygapophyseal) joints, ligamentous structures (including the anterior and posterior longitudinal ligaments, ligamentum flavum, and interspinous ligaments), and surrounding muscles and soft tissues that stabilize and move the segment Spine-healthCleveland Clinic.
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Structure & Location:
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Vertebral Bodies: C5 and C6 are roughly the size of a small bean and bear axial load.
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Facet Joints: Each vertebra has superior and inferior articular facets that interlock, guiding and limiting motion.
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Disc: Provides cushioning and allows slight motion between C5 and C6.
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“Origin” & “Insertion” (Articulations):
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C5’s inferior facets articulate with C6’s superior facets; C6’s inferior facets articulate with C7’s superior facets.
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Blood Supply:
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Primarily via small branches of the vertebral and ascending cervical arteries, which penetrate the vertebral bodies and posterior elements Physiopedia.
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Nerve Supply:
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Branches of the cervical dorsal rami innervate facet joints, and sinuvertebral nerves supply the disc and ligamentous structures Cleveland Clinic.
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Key Functions:
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Flexion/Extension: Nods and tilts head forward/backward.
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Lateral Flexion: Bends head side to side.
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Rotation: Turns head left/right.
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Load Bearing: Supports head weight (~4.5–5.5 kg).
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Shock Absorption: Disc and ligaments absorb forces during movement.
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Protecting Neural Elements: Maintains space for the spinal cord and exiting nerve roots.
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Types of Cervical Spondylolisthesis (Slip)
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Anterior Slip (Anterolisthesis): Forward displacement of C5 on C6.
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Posterior Slip (Retrolisthesis or “Backward Slip”): Backward displacement of C5 relative to C6.
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Dysplastic: Congenital malformation of facet joints or pars interarticularis.
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Isthmic: Defect or fracture of the pars interarticularis (rare in cervical spine).
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Degenerative: Age-related disc and facet joint wear causing instability.
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Traumatic: Acute injury (e.g., facet dislocation, hangman’s fracture) PMCuniversityspinecenter.com.
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Pathological: Resulting from tumors, infections, or systemic bone disease.
Causes
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Disc degeneration and loss of height PMC
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Facet joint arthrosis (wear-and-tear) PMC
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Acute trauma (e.g., whiplash, falls) PMC
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Congenital malformed facets or pars defects.
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Rheumatoid arthritis causing joint erosion.
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Osteoporosis weakening bony structures.
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Paget’s disease disrupting normal vertebral architecture.
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Tumors eroding bone (metastases, primary bone tumors).
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Infections (osteomyelitis, discitis).
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Repetitive microtrauma with sports or heavy labor.
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Poor posture leading to uneven loading.
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Obesity increasing axial load.
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Smoking impairing disc nutrition.
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Genetic predisposition to ligamentous laxity.
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Hypermobility syndromes (e.g., Ehlers–Danlos).
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Prior cervical spine surgery causing altered mechanics.
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Autoimmune spondyloarthropathies (e.g., ankylosing spondylitis).
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Diffuse idiopathic skeletal hyperostosis (DISH) stiffening the spine.
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Metabolic bone diseases (e.g., osteomalacia).
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Iatrogenic injury (e.g., radiation-induced bone loss).
Symptoms
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Neck stiffness.
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Localized neck pain.
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Pain radiating to the shoulder or arm (radiculopathy).
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Numbness or tingling in the arm or hand.
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Muscle weakness in the upper limb.
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Headaches at the base of the skull.
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Difficulty turning the head.
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Grinding or popping sensations (crepitus).
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Feeling of instability in the neck.
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Balance problems (if spinal cord is pinched).
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Gait disturbance or clumsiness.
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Loss of fine motor skills (buttons, writing).
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Hyperreflexia (overactive reflexes).
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Bowel or bladder dysfunction (rare, late).
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Muscle spasms in the neck or shoulder.
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Pain with coughing or sneezing.
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Worse pain when leaning forward or backward.
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Sleep disturbances due to pain.
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Fatigue from chronic discomfort.
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Anxiety or depression secondary to chronic pain.
Diagnostic Tests
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Plain X-rays: Lateral, anteroposterior, flexion/extension views to see slip and instability Mayo Clinic.
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MRI Scan: Shows disc, spinal cord, nerve root compression Mayo Clinic.
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CT Scan: Detailed bone anatomy to assess facet joints and pars defects.
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Myelogram: Dye in spinal canal plus CT to detect nerve compression.
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Electromyography (EMG): Assesses nerve conduction and muscle response.
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Nerve Conduction Studies (NCS): Measures nerve signal speed.
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Bone Scan: Detects stress fractures or tumors.
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Flexion–Extension Radiographs: Demonstrate dynamic instability.
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Ultrasound: Occasionally for muscle/fascia assessment.
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Blood Tests: ESR/CRP for infection or inflammation.
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WBC Count: Elevated in infection.
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Rheumatoid Factor/ ANA: Autoimmune screening.
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DEXA Scan: Bone density to evaluate osteoporosis.
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Discography: Reproduces pain by injecting dye into disc.
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Somatosensory Evoked Potentials (SSEPs): Measure spinal cord conduction.
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Pulmonary Function Tests: Preoperative assessment.
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Electrocardiogram (ECG): Preoperative cardiac risk.
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Blood Glucose/HbA1c: Preoperative metabolic evaluation.
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Nutrition Panel (Albumin): Surgical risk assessment.
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CT Angiography: Rarely, if vascular anatomy is needed before surgery.
Non-Pharmacological Treatments
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Physical Therapy: Strengthening and stabilization exercises.
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Traction: Cervical traction to relieve nerve pressure.
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Posture Training: Ergonomic assessment and correction.
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Heat Therapy: Relaxes muscles and improves blood flow.
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Cold Packs: Reduces inflammation and numbs pain.
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Transcutaneous Electrical Nerve Stimulation (TENS).
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Massage Therapy.
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Acupuncture.
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Chiropractic Mobilization (gentle).
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Cervical Collar (soft).
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Ergonomic Pillows & Mattresses.
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Yoga & Pilates (under guidance).
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Aquatic Therapy.
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Cervical Stabilization Braces.
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Dry Needling.
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Biofeedback.
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Ultrasound Therapy.
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Low-Level Laser Therapy.
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Kinesio Taping.
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Posture-Correcting Devices.
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Workstation Ergonomics.
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Weight Management.
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Smoking Cessation.
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Stress Management & Relaxation Techniques.
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Activity Modification: Avoid heavy lifting/neck hyperextension.
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Cervical Roll Exercises.
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Isometric Neck Exercises.
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Pilates Ball Stretches.
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Neck Strengthening with Resistance Bands.
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Education on Safe Lifting and Sleep Positions.
Drugs
| Drug | Class | Dosage | Timing | Common Side Effects |
|---|---|---|---|---|
| Ibuprofen | NSAID | 400–800 mg every 6 h | With meals | GI upset, heartburn, kidney strain |
| Naproxen | NSAID | 250–500 mg twice daily | Morning & evening | GI bleeding, dizziness |
| Celecoxib | COX-2 inhibitor | 200 mg once daily | Any time | Edema, hypertension |
| Acetaminophen | Analgesic | 500–1000 mg every 6 h | As needed | Liver toxicity (if >4 g/day) |
| Cyclobenzaprine | Muscle relaxant | 5–10 mg three times daily | At bedtime | Drowsiness, dry mouth |
| Tizanidine | Muscle relaxant | 2–4 mg every 6–8 h | As needed | Hypotension, weakness |
| Gabapentin | Antineuropathic | 300–600 mg three times daily | Titrate up | Sedation, peripheral edema |
| Pregabalin | Antineuropathic | 75–150 mg twice daily | Morning & evening | Dizziness, weight gain |
| Duloxetine | SNRI | 30 mg once daily | Morning | Nausea, insomnia |
| Amitriptyline | TCA | 10–25 mg at bedtime | Bedtime | Dry mouth, constipation |
| Tramadol | Opioid agonist | 50–100 mg every 4–6 h | As needed | Nausea, dependence |
| Oxycodone | Opioid agonist | 5–10 mg every 4–6 h | As needed | Constipation, respiratory depression |
| Prednisone | Oral steroid | 5–10 mg daily (short use) | Morning | Weight gain, hyperglycemia |
| Methylprednisolone | Oral steroid taper | 4–48 mg daily taper | Morning | Mood swings, osteoporosis (long) |
| Lidocaine patch | Topical analgesic | Apply 1–2 patches daily | 12 h on/12 h off | Skin irritation |
| Capsaicin cream | Topical analgesic | Apply 3–4 times daily | Any time | Burning sensation |
| Diclofenac gel | Topical NSAID | Apply 4 g up to 4× daily | Any time | Local rash |
| Methocarbamol | Muscle relaxant | 1500 mg four times daily | As needed | Drowsiness |
| Baclofen | Muscle relaxant | 5 mg three times daily | Titrate up | Weakness, drowsiness |
| Ketorolac | NSAID (IV/IM/PO) | 10 mg IV/IM, then 20 mg PO | Every 6 h (max 5 d) | GI bleeding, renal impairment |
Dosing may vary by patient weight, age, and comorbidities. Always follow a healthcare provider’s recommendation.
Dietary Supplements
| Supplement | Typical Dosage | Function | Mechanism of Action |
|---|---|---|---|
| Glucosamine | 1500 mg daily | Joint support | Precursor for cartilage synthesis |
| Chondroitin | 1200 mg daily | Cartilage hydration | Stimulates proteoglycan production |
| Omega-3 (Fish Oil) | 1000–3000 mg daily | Anti-inflammatory | Inhibits pro-inflammatory eicosanoids |
| Turmeric (Curcumin) | 500–2000 mg daily | Anti-inflammatory | Blocks NF-κB and COX-2 pathways |
| MSM (Methyl Sulfonyl Methane) | 1000–2000 mg daily | Pain relief | Sulfur donor for connective tissue repair |
| Vitamin D3 | 1000–2000 IU daily | Bone health | Promotes calcium absorption |
| Calcium | 1000–1200 mg daily | Bone strength | Structural component of bone matrix |
| Magnesium | 300–400 mg daily | Muscle relaxation | Modulates NMDA receptor activity |
| Vitamin B12 | 500–1000 µg daily | Nerve health | Methylation and myelin synthesis |
| Collagen Peptides | 10 g daily | Connective tissue repair | Provides amino acids (glycine, proline) |
Surgical Options
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Anterior Cervical Discectomy & Fusion (ACDF): Remove disc and fuse C5–C6 with bone graft and plate.
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Posterior Cervical Fusion: Stabilize from back using rods and screws.
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Cervical Laminectomy: Remove lamina to decompress spinal cord.
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Laminoplasty: Expand spinal canal by hinging open lamina.
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Foraminotomy: Widen nerve root exit foramen.
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Total Disc Replacement: Replace disc with artificial implant.
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Corpectomy: Remove vertebral body (e.g., C5) and reconstruct with graft.
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Osteotomy: Cut and realign vertebra for deformity correction.
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Posterior Cervical Laminoforaminotomy: Combined decompression of lamina and foramen.
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Minimally Invasive Cervical Fusion: Small incisions and tubular retractor.
Prevention Strategies
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Maintain good posture while sitting, standing, and sleeping.
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Use ergonomic workstations and chairs.
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Strengthen neck and shoulder muscles regularly.
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Avoid carrying heavy loads on one side.
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Practice safe lifting techniques (lift with legs).
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Keep a healthy body weight to reduce spinal load.
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Quit smoking to preserve disc nutrition.
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Ensure adequate intake of calcium and vitamin D.
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Take regular breaks during prolonged desk work.
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Use supportive pillows to maintain cervical alignment during sleep.
When to See a Doctor
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Progressive weakness or numbness in arms or hands.
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Difficulty walking, balance issues, or falls.
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Loss of bowel or bladder control.
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Severe, unremitting pain not relieved by rest or medication.
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Pain radiating beyond the shoulder into the arm/hand.
Frequently Asked Questions
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What is a backward slip (retrolisthesis)?
A backward slip occurs when C5 moves posteriorly relative to C6, compressing structures behind it. -
How does it differ from anterolisthesis?
In anterolisthesis, the vertebra slips forward; in retrolisthesis, it slips backward. -
Can a backward slip heal on its own?
Mild slips may stabilize with conservative care, but structural damage often remains. -
Are X-rays enough to diagnose it?
Flexion–extension X-rays show dynamic instability, but MRI/CT define soft tissue and neural involvement. -
What activities worsen symptoms?
Hyperextension (looking up), heavy lifting, and prolonged static postures often aggravate pain. -
Is surgery always required?
No—many patients improve with non-surgical treatments unless neurological deficits progress. -
How long is recovery after ACDF?
Fusion typically takes 3–6 months; return to full activity by 6–12 months under guidance. -
Can I exercise with retrolisthesis?
Gentle, supervised strengthening and range-of-motion exercises are beneficial if approved by your doctor. -
What is the role of a cervical collar?
A soft collar limits extreme motion and can help reduce pain acutely but is not a long-term solution. -
Are dietary supplements effective?
Supplements like glucosamine and turmeric may reduce inflammation but should complement, not replace, medical treatment. -
Can retrolisthesis cause headaches?
Yes—upper cervical instability can refer pain to the base of the skull. -
Will weight loss help?
Reducing body weight decreases axial load on the cervical spine and can relieve symptoms. -
Is physical therapy painful?
Modalities are tailored; some discomfort may occur during strengthening, but pain should not worsen long-term. -
How often should I get imaging?
Follow-up imaging is typically every 6–12 months or sooner if symptoms change. -
What is the long-term outlook?
With proper management, many patients maintain a good quality of life; untreated severe slips can lead to permanent nerve damage.
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.
