C4-5 spondylolisthesis is shown on these x-rays by Dr. Castanet. This was a 60+ year old woman with complaints of neck, head, shoulder and left arm pain. She has previous relief, for a while, from physical therapy and a cervical epidural steroid injection. But her pain had returned and she wanted to see if I could help her with spinal decompression treatment. She had already had a CT scan of her neck and an MRI scan of her neck. The CT report indicated multi-level spondylolistheses. The MRI report indicated none, and I did not have access to any of the imaging yet. Given the discrepant reports, and because x-rays are uniquely effective in evaluating unstable spondlyolistheses, I sent her for cervical x-rays, and this is what I will show you. This lady’s x-rays showed spondylolisthesis at just one level, C4-5, but it seems to be unstable, i.e. moving further forward with flexion of her neck, and further backward with extension of her neck.
Since her spondylolisthesis was not severe, but was “on the fence”, or borderline between bad and modest, I tried a gentle amount of spinal decompression treatment for her. She felt dramatically better after the first treatment, but after the second treatment, she said her neck felt better, but her upper back felt worse. I think, in fact, the treatment may have exacerbated her symptoms, so I decided to refer her to a neurosurgeon for evaluation.
Spondlyolistheses tend to be slowly progressive in severity, so I expect, at some point, she is going to need surgical fusion of this “slip”. Having spent 5 years with a neurosurgeon, I have a pretty good idea how they think about these problems. Nonetheless, there is a good deal of “grey area” and judgement and timing involved in evaluating these problems, so doctors and surgeons can differ in their opinions about when surgery is appropriate. I think, given the severity, recurrence and intractability of her pain, given her efforts at physical therapy, my treatment, and pain management, with a cervical epidural steroid injection, the neurosurgeon will probably offer her surgical treatment for this problem, and to protect her spinal cord from the potential injury from narrowing of the spinal canal, as the bone slips back and forth.
If I can help you with your neck or back problem, please call me at 404-558-4015.
