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Condition/Disorder Synonyms

  • Cervical spondylolisthesis

ICD-9-CM Code

  • 738.4 Acquired spondylolisthesis

  • 756.12 Spondylolisthesis congenital

  • 805.02 Closed fracture of second cervical vertebra

ICD-10-CM Code

  • 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 Pattern1

Key Features


  • 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 then 50% displacement

  • High-grade isthmic spondylolisthesis: greater then 50% displacement

  • 4 grades2

    • Grade 1: 0-25% slippage

    • Grade 2: 25-50% slippage

    • Grade 3: 50-75% slippage

    • Grade 4: 75-100% slippage

  • Spondylolysis: fracture without displacement

General Considerations

  • Instability

  • Avoid extension positions that increase symptoms

  • Wiltse-Newman classification of spondylolisthesis


  • May be congenital or acquired

Clinical Findings

Signs and Symptoms

  • Cervical, shoulder, arm, upper extremity pain and parasthesia, often radiating into the lower extremities if central cord involvement

  • Constricted pupil (Horner's 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

Functional Implications

  • Difficulty sustaining standing postures secondary to neck and arm pain

  • Inability to sleep flat on the back without a pillow

  • Weakness with lifting

  • Loss of movement or feeling in the upper extremity

  • Difficulty with movements secondary to pain, especially reaching overhead

  • Limited sports participation

Possible Contributing Causes

  • Forceful extension from hit under the chin (sports)

  • Congenital

  • Car accident, hit from rear

  • Hyperextension of the cervical spine

  • Suicidal hanging

  • Increased cervical lordosis posture

Differential Diagnosis

  • Peripheral nerve impairment

  • Spinal tumor

  • Infection

  • Peripheral neuropathy

  • Paraspinal spasms

  • Degenerative disk disease

  • Stenosis

Means of Confirmation or Diagnosis


  • MRI helpful in diagnosis to visualize compressed or inflamed nerve root

  • X-ray/plain-film radiograph to see vertebra position (Scottie dog collar)

  • CT scan to show herniation compressing the spinal canal or nerves

  • Electrodiagnostic/nerve conduction testing can help to determine a specific impaired nerve function

Findings and Interpretation

  • Cervical ...

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