Cervical Spondylolisthesis

What it is

Spondylolisthesis means one vertebra has slipped forward on the one below it. In the neck this is less common than in the lower back, and it usually comes from the joints and ligaments loosening with age (degenerative), though it can also follow an injury. The slip can narrow the canal and crowd the spinal cord or a nerve root.

What it feels like

Many people have neck pain and stiffness. If the slip narrows the canal enough, it can add the arm symptoms of a pinched nerve or the broader signs of cord involvement — hand clumsiness, balance trouble — which are the ones I watch for most closely.

How we diagnose it

Standing X-rays show the slip, and bending (flexion–extension) views reveal whether the segment is unstable — whether it moves more than it should. An MRI shows how much the cord and nerves are crowded. Both pieces guide the plan.

How we treat it

A stable slip without nerve or cord pressure is often managed without surgery — physical therapy, activity adjustments, and time. When symptoms persist, or there is instability or cord compression, surgery relieves the pressure and, because the segment is already slipping, usually includes a fusion to steady it. I fuse only what truly needs it, since a fused level adds stress to its neighbors over the years.

The science — for the curious

As in the lower back, the presence of a slip on imaging is not the same as needing surgery — plenty of slips are stable and stay quiet. What changes the conversation is instability on bending films or signs that the cord or a nerve is being compressed. When a fusion is the right call here, it is because the level has lost the stability it needs, not because of the slip’s appearance alone.

Learn more

OrthoInfo — Cervical Spondylosis (Arthritis of the Neck): orthoinfo.aaos.org

OrthoInfo — Neck Pain: orthoinfo.aaos.org

This handout is general education about a common condition and does not replace the personalized advice we discuss in clinic. If anything here does not match what we talked about, what we talked about wins — please ask me.