116: CERVICAL SPONDYLOLISTHESIS

Eric Shamus, PhD, DPT, PT, CSCS; Eric J. Chaconas, DPT, PT, FAAOMPT

CONDITION/DISORDER SYNONYM

Cervical spondylolisthesis

ICD-9-CM CODES

738.4 Acquired spondylolisthesis
756.12 Spondylolisthesis congenital
805.02 Closed fracture of second cervical vertebra

ICD-10-CM CODES

M43.10 Spondylolisthesis, site unspecified
Q76.2 Congenital spondylolisthesis
S12.100A Unspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture
S12.101A Unspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture

PREFERRED PRACTICE PATTERN

4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and ROM Associated with Localized Inflammation¹

PATIENT PRESENTATION

A 50-year-old man presents with a gradual onset of neck pain for 2 years. Plain-film radiographs reveal a low-grade spondylolisthesis of the C5 vertebrae. He reports the symptoms are worse while lying supine, cervical backward bending, and prolonged sitting postures. A palpable step is noted in the mid cervical spine along with increased paraspinal muscle tone. Neurologic signs and instability testing are all negative. Decreased motor control and endurance of the deep neck flexors are noted along with decreased joint mobility in the upper thoracic spine.

KEY FEATURES

Description

Anterior (forward) translation of a vertebra
Fracture of the pedicles on the vertebra below
Slipping of the vertebra in relationship to the vertebra below
Neurogenic claudication
Fracture widens at the pars
Hangman’s fracture
C2 vertebra anterior translated on C3 with fracture of C2 pedicles

Essentials of Diagnosis

Made by X-ray
May be acquired or congenital
Clinical examination may find step deformity
Dermatome/myotome pattern
Low-grade isthmic spondylolisthesis: less than 50% displacement
High-grade isthmic spondylolisthesis: greater than 50% displacement
Four grades²
- Grade 1: 0% to 25% slippage
- Grade 2: 25% to 50% slippage
- Grade 3: 50% to 75% slippage
- Grade 4: 75% to 100% slippage
Spondylolysis: Fracture without displacement

FIGURE 116-1

A. Lateral radiograph of a 50-year-old man with neck pain and myelopathy. B. Sagittal T2-weighted MRI showing spinal cord compression at C4–5 at the level of the spondylolisthesis. (From Doherty GM. Current Diagnosis & Treatment: Surgery. 13th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

Instability
Avoid extension positions that increase symptoms
Wiltse–Newman classification of spondylolisthesis²

Demographics

May be congenital or acquired.

CLINICAL FINDINGS

SIGNS AND SYMPTOMS

Cervical, shoulder, arm, and upper extremity pain and paresthesia, often radiating into the lower extremities if central cord involvement
Constricted pupil (Horner sign)
Stiffness along spine
Headaches
Pain in cervical spine worsens with extension
Diminished sensation, motor control, and reflexes in the distribution of the involved nerve
Neurogenic claudication

TABLE 116-1Examination Findings and ...

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