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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.)

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 the Possible Conditions Causing Them

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