The Natural History of Degenerative Spondylolisthesis of the Cervical Spine With 2-to 7-Year Follow-up

Abstract

STUDY DESIGN: Retrospective study. OBJECTIVE: To determine whether cervical degenerative spondylolisthesis is unstable and/or progresses. SUMMARY OF BACKGROUND DATA: Cervical degenerative spondylolisthesis is relatively common in the elderly. However, there are no reports regarding its natural history. METHODS: We identified 27 patients with cervical degenerative spondylolisthesis (3.9%) from a database of 697 patients, using cervical radiographs. All had neutral and dynamic lateral radiographs at baseline and at a minimum of 24 months later (mean 39 mo, range, 24-92 mo). The mean age of the patients at the initial visit was 59.0 years (range, 50-83 yr). Male to female ratio was 16:11. Radiographical findings and clinical symptoms related to spondylolisthesis were assessed at initial and final follow-up. RESULTS: Eleven patients had cervical spondylolisthesis at C4-C5, 9 at C3-C4, 6 at C5-C6, and 1 at C2-C3. Initially, 6 had anterolisthesis and 21 had retrolisthesis. At baseline, 3 of 6 patients with anterolisthesis and 7 of 21 patients with retrolisthesis had translation of more than 2 mm on dynamic views. At baseline, 11 had no cervical symptoms, 8 had cervicalgia, 7 had radiculopathy, and 1 had myelopathy. At the final visit, none of the anterolistheses or retrolistheses had progressed. At the final visit, 7 of 10 patients with initial translation of more than 2 mm on dynamic views had no change. Of 17 patients with less than 2 mm of initial dynamic motion, 3 patients progressed to have more than 2 mm of dynamic translation. All 3 of these had retrolisthesis initially. None had clinical worsening of symptoms at the final visit. CONCLUSION: The natural history of cervical degenerative anterolisthesis and retrolisthesis seems to be stable during 2 years to nearly 8 years. Although those with retrolisthesis seem to have a higher propensity to increase their subluxation, none experienced dislocation or neurological injury. LEVEL OF EVIDENCE: 4.