Spondylolisthesis in the neck is one of the less prevalent degenerative spinal conditions, especially compared to spondylolisthesis in the lower back. The condition occurs when a vertebra slips forward and onto the vertebra located directly beneath it, usually because the vertebrae are receiving inadequate support from the other anatomical components of the spine. The lower back is more typically affected by the degenerative changes that occur as an individual ages due to the fact that this region of the spine is tasked with supporting the greatest amount of body weight. That said, however, the neck is also at risk -- albeit a lower one -- for developing spondylolisthesis because of the burden the weight of the head places on this region of the spine.
Causes of Spondylolisthesis in the Neck
As already noted, the degenerative changes that take place in the spine as an individual ages are the most common contributors to the development of spondylolisthesis in the neck. These changes can affect different components of the spine and lead to a number of degenerative spinal conditions, including:
Degenerative disc disease - Intervertebral discs are positioned between each of the spine's articulating vertebrae. These saucer-shaped pads are responsible for absorbing the impact that is placed on the spine when it bears weight or facilitates movement and are also tasked with preventing vertebrae from coming into contact with one another. Over time, the discs can lose water content and become weak and brittle, often contributing to the development of herniated or bulging discs. Intervertebral discs that are damaged in these ways are unable to provide the surrounding the vertebrae with the support they need, which can lead to the development of spondylolisthesis.
Facet disease - Facet disease is a type of arthritis that affects the spine's facet joints, which are tasked with connecting articulating vertebrae and enabling the neck and back to bend, twist, and otherwise move. The facet joints are coated in a thin layer of cartilage that lubricates the joints as they articulate and prevent the bones from uncomfortably grinding against one another. As an individual ages, however, the joints' cartilaginous lining can wear away, leaving the joints exposed, which allows the joints to rub against one another. This can lead to joint inflammation and loss of mobility (especially if a patient's facet disease leads to the formation of bone spurs), which can, in turn, contribute to the development of spondylolisthesis.
Symptoms of Spondylolisthesis in the Neck
Spondylolisthesis is evaluated in terms of grades that indicate the degree to which the affected vertebra has slipped out of place. There are five different grades of spondylolisthesis that can be more generally classified into two groups: low-grade spondylolisthesis and high-grade spondylolisthesis. High-grade spondylolisthesis rarely, if ever, occurs in the neck and when it does, patients are typically faced with a very serious medical condition. Low-grade spondylolisthesis, on the other hand, is more common and can even go unnoticed by some patients. In general, low-grade spondylolisthesis causes symptoms of localized neck pain and radiculopathy, which is pain, numbness, and tingling that travel along the length of a spinal nerve. Vertebrae that have experienced some degree of slippage can very easily compress a nearby spinal nerve, making radiculopathy a very common symptom amongst spondylolisthesis patients. When spondylolisthesis occurs in the neck, patients can experience these symptoms in the neck, upper back, shoulders, arms, and/or hands. Because the condition's symptoms often occur in seemingly unrelated areas of the body, many patients improperly assume that the root of their discomfort lies in their arms or hands, for instance. These patients sometimes dedicate weeks and months to treating their upper limbs when, in fact, they should be treating their necks. For this reason, those who experience chronic pain in any areas of the body should consult a physician to ensure they're receiving the care that their bodies require.
Treating Spondylolisthesis with Medication
Many of those who suffer from spondylolisthesis in the neck will be advised by their physicians to take over-the-counter, nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen. These drugs reduce inflammation and relieve pain by blocking the body's production of the COX-1 and/or COX-2 enzymes, which are released as part of the inflammatory response. Those who suffer from cardiovascular or gastrointestinal conditions may be unable to take NSAIDs and may, instead, be advised to take over-the-counter analgesics such as acetaminophen. If a patient's pain is severe or is interfering with his or her quality of life, their physician may prescribe narcotic pain relievers or muscle relaxants.
Physical Therapy for Spondylolisthesis
Working with a physical therapist to strengthen the muscles in the neck and upper back can oftentimes prove beneficial to patients who have been diagnosed with spondylolisthesis in the neck. The additional support that the spine receives from strong and healthy muscles can sometimes make up for the lack of support it's receiving from arthritic facet joints or herniated or bulging discs.
Physical therapists may employ other treatment techniques in addition to strength training, especially cryotherapy and/or thermotherapy. During cryotherapy, an ice pack or other cold source is applied to the neck in an effort to numb pain and reduce swelling. Thermotherapy, on the other hand, entails the application of a heating pad or other heating element to the neck so as to increase blood flow to the area and promote healing. Other treatment techniques can include transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound, and posture modification exercises, among others.
Surgery for Spondylolisthesis in the Neck
The majority of those who are afflicted with spondylolisthesis in the neck will receive adequate relief from the use of conservative, nonsurgical treatments such as pain medication and physical therapy. Those who continue to suffer after weeks or months of conservative treatment, however, may be advised to undergo surgical treatment. In the past, patients were limited to open spine surgery, which entailed the complete removal of intervertebral discs and spinal fusion to prevent further mobility in the affected area of the spine. These operations often required lengthy hospital stays and demanding rehabilitations. Many patients also faced additional surgeries down the road due to the prevalence of failed back surgery syndrome (FBSS), or the worsening or continuation of symptoms following surgery.
New advances in medical technology now enable some patients to undergo endoscopic treatments in lieu of open spine surgeries. These procedures are performed on an outpatient basis, under local anesthesia and deep IV sedation. None of the spine's components are removed in their entirety and spinal fusion is not required, allowing patients to retain their full range of motion following the procedure. Rehabilitation typically takes a matter of weeks and those who undergo an endoscopic spine procedure face a reduced risk for developing FBSS than those who undergo open spine surgery.
Patients who are advised to undergo surgery for spondylolisthesis in the neck should ask their physicians if they are candidates for a minimally invasive procedure instead. Both types of surgeries come with their own risks and benefits, and these should be evaluated before a patient consents to either one. It may also be advisable to seek a second opinion to ensure surgical treatment is necessary.
