What are the next steps for a patient with posterior chest pain and 2mm anterolisthesis of C5 upon C6 noted on X-ray (X-ray)

From the Guidelines

For a patient with posterior chest pain and 2mm anterolisthesis of C5 upon C6 noted on X-ray, the next steps should include referral to a spine specialist (neurosurgeon or orthopedic spine surgeon) for comprehensive evaluation. In the interim, conservative management is appropriate with pain control using NSAIDs such as ibuprofen 400-600mg every 6-8 hours or naproxen 500mg twice daily with food 1. A short course of muscle relaxants like cyclobenzaprine 5-10mg at bedtime may help with associated muscle spasms. Physical therapy focusing on cervical spine stabilization exercises should be initiated. The patient should avoid activities that exacerbate pain and consider a soft cervical collar for short-term use during acute pain episodes. Advanced imaging with MRI of the cervical spine is necessary to assess for spinal cord compression, nerve root impingement, and ligamentous injury. This is crucial because anterolisthesis indicates vertebral slippage that could potentially compromise neural structures. The 2mm measurement represents moderate instability that requires proper evaluation before determining if surgical intervention is needed. The connection between posterior chest pain and cervical findings should be carefully assessed, as referred pain patterns from cervical pathology can manifest in the thoracic region 1.

Some key points to consider in the management of this patient include:

• The importance of early referral to a spine specialist for comprehensive evaluation and guidance on further management 1.
• The role of conservative management, including pain control and physical therapy, in the initial treatment of patients with cervical spine instability 1.
• The need for advanced imaging, such as MRI, to assess for potential complications such as spinal cord compression or nerve root impingement 1.
• The importance of careful assessment of the connection between posterior chest pain and cervical findings, as referred pain patterns can manifest in the thoracic region 1.

Overall, the management of this patient requires a multidisciplinary approach, including referral to a spine specialist, conservative management, and advanced imaging to assess for potential complications.

From the Research

Next Steps for Patient with Posterior Chest Pain and 2mm Anterolisthesis of C5 upon C6

• The patient's condition involves a 2mm anterolisthesis of C5 upon C6, which indicates a slight instability in the cervical spine 2.
• Given the presence of posterior chest pain and the X-ray findings, it is essential to consider the optimal positioning for cervical immobilization to protect the spinal cord 3.
• A study suggests that a slight degree of flexion, equivalent to 2 cm of occiput elevation, can produce a favorable increase in spinal canal/spinal cord ratio at levels C5 and C6 3.
• However, another study found that cervical collars are insufficient for immobilizing an unstable cervical spine injury, and further research is needed to develop effective immobilization techniques 2.
• In cases of traumatic spondylolisthesis of the lower cervical spine with concomitant bilateral facet dislocations, priority should be given to treating respiratory problems, and a posterior approach reduction, stabilization, and fusion treatment may be necessary 4.
• It is also important to consider the potential neurologic complications following immobilization of cervical spine fracture, particularly in patients with ankylosing spondylitis, and to alter standard stabilization recommendations accordingly 5.
• The use of MRI as an adjunct to cervical spine clearance may be beneficial in evaluating ligamentous edema or injury not seen on CT, but it does not substantially add to the decision-making process in patients with normal CS CT and a localizing physical examination 6.