What C4-C5 Retrolisthesis Means
C4-C5 retrolisthesis means that your fourth cervical vertebra (C4) has slipped backward relative to the fifth cervical vertebra (C5) below it. This is a type of spinal misalignment in your neck where one bone has moved out of its normal position.
Understanding the Condition
Retrolisthesis is the backward displacement of one vertebra on the vertebra below it, which can narrow the spinal canal and compress nerves or the spinal cord 1, 2.
This condition typically develops from degenerative changes in the discs, facet joints, and supporting ligaments of your spine that occur over time 2, 3.
The C4-C5 level is a common location for this problem because it sits in the mid-cervical spine where significant motion occurs 2, 3.
What Symptoms This Can Cause
You may experience neck pain that can radiate down your arm if the slippage compresses nerve roots exiting at that level 1, 2.
Numbness, tingling, or weakness in your shoulders or arms can occur if the C5 nerve root becomes compressed 1, 2.
In more severe cases, you might develop myelopathy (spinal cord compression) causing problems with balance, coordination, hand dexterity, or leg weakness 2, 3.
Interestingly, neck pain is often the initial symptom but may actually decrease as neurological symptoms become more prominent 2.
How Serious Is This?
The severity depends on whether the spine is stable or unstable, which your doctor determines through flexion-extension X-rays that show if the slippage increases with neck movement 2, 3.
Most cases are stable and can be managed conservatively with physical therapy, chiropractic care, pain medications, and activity modification 1.
Unstable retrolisthesis or cases with significant nerve/spinal cord compression require surgical intervention to decompress neural structures and stabilize the spine 2, 4, 3.
What Happens Next
Your doctor will order imaging studies including X-rays, MRI, and possibly CT scans to assess the degree of slippage, nerve compression, and spinal cord involvement 2.
Flexion-extension radiographs are essential to determine if your spine is unstable at this level 2, 3.
If you have only neck pain without neurological symptoms and stable imaging, conservative treatment is the first approach including physical therapy, anti-inflammatory medications, and possibly neuropathic pain medications like gabapentin 1.
Surgery becomes necessary if you develop progressive neurological deficits, severe spinal cord compression (myelopathy), or if conservative treatment fails after an adequate trial 2, 4, 3.
Important Points to Remember
This condition develops gradually from wear-and-tear changes in your spine, not from a single injury in most cases (unless you've had trauma) 2, 3.
The presence of retrolisthesis on imaging doesn't automatically mean you need surgery—treatment decisions are based on your symptoms and whether nerves or the spinal cord are compressed 1, 2.
If surgery is recommended, the goals are to decompress the spinal cord or nerves, correct the alignment, and fuse the unstable segment 2, 3.
Avoid activities that involve extreme neck flexion or extension until your doctor evaluates the stability of your spine 2.