From the Guidelines
Yes, neck stiffness can definitely be caused by anterolisthesis and retrolisthesis in the cervical spine with the described encroachments. These conditions involve vertebral misalignments where one vertebra slips forward (anterolisthesis) or backward (retrolisthesis) relative to an adjacent vertebra. The encroachments described at C2-C3 and C3-C4 levels indicate that these misalignments are causing some compression of surrounding structures. When vertebrae shift out of proper alignment, they can irritate nearby nerves, cause inflammation, and trigger protective muscle spasms, all of which contribute to neck stiffness. The moderate encroachment at C2-C3 on the left side is particularly likely to cause noticeable symptoms, as cervical radiculopathy is defined as a syndrome of pain or sensorimotor deficits that are due to dysfunction of a cervical spinal nerve, the roots of the nerve, or both 1.
Key Points to Consider
- The presence of anterolisthesis and retrolisthesis can lead to mechanical stress on the surrounding tissues, disrupting normal biomechanics and leading to compensatory muscle tension as the body tries to protect and stabilize the affected area.
- Treatment typically includes physical therapy focusing on cervical stabilization exercises, anti-inflammatory medications like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily with food) for 1-2 weeks, and possibly muscle relaxants such as cyclobenzaprine (5-10mg at bedtime) for short-term use 1.
- Heat therapy and gentle stretching can also help relieve muscle tension, and it is essential to consider the patient’s medical history to accurately guide imaging and treatment.
- The differential diagnosis of cervical or neck pain includes consideration of acute versus chronic, neuropathic versus nonneuropathic, and musculoskeletal versus nonmusculoskeletal processes, and imaging may not be required at the time of initial presentation in the absence of red flag symptoms 1.
Recommendations
- Physical therapy and anti-inflammatory medications should be considered as the first line of treatment for neck stiffness caused by anterolisthesis and retrolisthesis in the cervical spine.
- Imaging may be necessary to confirm the diagnosis and rule out other potential causes of neck pain, but it should be guided by the presence of red flag symptoms or the failure of conservative treatment measures 1.
- A thorough medical history and physical examination are essential to determine the underlying cause of neck stiffness and to develop an effective treatment plan.
From the Research
Neck Stiffness and Cervical Spine Anterolisthesis and Retrolisthesis
- Neck stiffness can be a symptom of various cervical spine conditions, including anterolisthesis and retrolisthesis.
- Anterolisthesis and retrolisthesis refer to the forward and backward slippage of a vertebra in the spine, respectively 2.
- A study on cervical spondylotic myelopathy in the elderly found that degenerative spondylolisthesis of the cervical spine can cause intense cord compression and lead to symptoms such as neck stiffness 2.
Cervical Spine Encroachment and Neck Stiffness
- The presence of minimal bony encroachment on the right C3-C4 and moderate encroachment on the left C2-C3 and minimal encroachment at C3-C4 may contribute to neck stiffness.
- However, the exact relationship between the degree of encroachment and neck stiffness is not clearly established in the provided studies.
- A study on lumbar spondylolisthesis found that degenerative spondylolisthesis can cause low back pain and stiffness, but the findings may not be directly applicable to the cervical spine 3.
Management of Cervical Spine Anterolisthesis and Retrolisthesis
- The management of cervical spine anterolisthesis and retrolisthesis may involve conservative strategies such as physical therapy and pain management, as well as surgical intervention in severe cases 4, 3.
- A study on physiotherapeutic rehabilitation for L5-S1 anterolisthesis management found that physical therapy can play a crucial role in reducing pain and improving functional recovery 4.