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