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Is Spondylolisthesis serious?

theresettherese Posts: 13
edited 06/11/2012 - 8:55 AM in Neck Pain: Cervical
Hi, My name is Therese. I posted a few months ago but didn't get much response so I thought I would just ask one question at a time, haha. I am a 17 year old girl who started having neck pain about 2 years ago.

It has dramatically increased in the last 5 months to the point where daily functioning is difficult. I've had several MRI's and X-Rays that have shown spondylolisthesis at c2-c3 and c4-c5 along with some disc protrusions, one that is flattening my spinal cord.

Several doctors I have seen have told me that 'everyone has disc bulges, they don't usually cause problems.' I don't understand that because it seems that so many people get surgery for these conditions.

I am wondering at what mm spondylolisthesis is considered serious. my MRI says it is 3mm, and does not give a Grade. Everywhere I look online says c2-c3 spondylolisthesis is an injury typically seen after someone's hung themselves! How can that not be serious? Thank you for any feedback you can offer. -Therese


  • Have you seen a board certified fellowship trained Neuro or Ortho Surgeon (specializing in spinal reconstruction)?

    If you were my daughter I would insist that you see one of these specialist. I would insist upon flexion extension x-rays and possibly an emg test.

    There are some treatments that can help/work. Many people have success with traction, massage and PT but the specialist would look at your images and test results and decide what the nest option for you is.

    What symptoms are you having now? What doctors are you working with?


  • and welcome to Spine Health. :H

    I wonder what Grade Spondylolisthesis you have. I would imagine it is only a low grade, otherwise I think they would be talking about surgery. A slipped vertebra in your neck could cause damage to the spinal cord if it is creating much stenosis.

    Now, I am not an expert, just someone who had a Grade 2 spondylolisthesis in my lumbar spine and had a fusion surgery for it. However, I reached the grand old age of being in my 50s before that happened. By that time I had very severe stenosis that was causing all sorts of neurological symptoms and awful sciatica in both legs every day, that had me in tears some days.

    I don't know if 3mm is a large slip or not, but I suspect if they are not talking about surgery, it probably isn't. I would imagine that they are going to watch you carefully to see how it progresses.

    I have cervical spondylosis in my neck from C3 to C7 and at C3/4 and C4/5, there is compression of my cord, but my MRI scan didn't have high signal. That would indicate that the cord was being damaged, but as most of my symptoms don't indicate cord damage, we are watching and waiting to see how things progress.

    I am having EMG and nerve conduction studies done this Saturday just to be on the safe side.
    They did flexion and extension x-rays of my neck to make sure that there wasn't spinal instability and none was evident. Have you had those x-rays done?

    Have you been in some sort of accident to have this damage in your neck at such a young age?

    Do hang out with us and keep us informed of how you are doing. >:D<
  • I have seen an orthopedic surgeon that barely looked at my MRI and didn't look at my X-Rays. I was pretty much dismissed. I had an MRI as well as flexion/ extension X-Rays on the same day. The Mri showed the spondylolisthesis but the X-Rays report said everything was normal! I am increasingly confused because several of my reports seem to contradict eachother.

    I have had an EMG also just last week and the technician said everything looked normal. I am having symptoms of nerve impingment- pain radiating into shoulder and down arm. Stiffness and weakness in arms/ hands- I seem to drop things alot more frequently now. I also have a very stiff neck and extreme muscle tension there as well as my upper back. I also have pressure and pain in my head. My neck often feels weak like it is hard to hold it up.

    I have not been in any notable accidents that would cause a neck injury but I did receive a blow to the head 2 years ago but did not have a concussion or neck pain immediatly after. I do have scoliosis in my lower and upper back but doctors say it is not significant.

    I had PT last summer but at that time my neck pain was nowhere what it was now. This year was mostly pain free until one week in April when all these symptoms started. I had never had arm pain prior to this.

    Sorry if all this information is confusing, I have somewhat of a complicated history. I am currently seeing a neurologist who will probably not know what to do with me next after receiving my apparently normal EMG results.

    Once again thanks for any input! -Therese
  • Hi Theresa,

    Here is the standards that are used in deciding wether disc are bulging or protrusions.

    Desiccation-loss of disk water
    Disk bulge-circumferential enlargement of the disk contour in a symmetric fashion
    Protrusion-a bulging disk that is eccentric to one side but<3mm beyond the vertebral margin.
    Herniation-disk protrusion that extends more than 3 mm beyond the vertebral margin.
    Extruded disk-extension of nuclues pulposus through the anulus into the epidural space.
    Free fragment-epidural fragment of disk no longer attached to the parent disk.

    The reason I put this in here, is so you can see the 3mm measurement is a common measurement in reading mri's. As far as the part about having issues at c2-c3 is something that happens with hanging, well I have them and certainly that is nothing I ever tried.

    As far as your emg findings. they are not a 100% accurate, as sometimes they give false negatives. What is more important is the doctors clinical findings when they exam you. They will test your reflexes and look for things such as hyper reflexes, also there are a number of test they do, such as flicking your fingers to see what happens. I would look for a spine doctor whom is dealing with pediatric issues given your age. Typically in the cervical spine they don't grade as they do in the lumbar spine. The cervical spine is much smaller, so the measurements are different. The measurements I gave you go for the cervical spine and not the lumbar.

    Your primary doctor is it still a pediatrician or a regular GP? Ask them if you were their child whom would they see. The other thing is at your age, maybe they are thinking some conservative treatments will get you back going again. Keep in mind the common surgical procedure for cervical spine issues is fusion, which will forever change the functioning of the spine, as well as you will loose some ROM(range of motion). Once they begin fusing in the cervical spine it also puts additional stress on the other levels, which can cause them to herniate as well.

    But I do think it is important you get treatment, and there are doctors out there whom can help you. You might also look at neurologist or nuerosurgeon, but I would make sure they have done work in pediatrics as your young and it does make a difference, plus you might find more compassion dealing with a surgeon whom has dealt with younger people.
  • My primary doctor is a GP. I don't know if it makes any difference but she is a PA and not an MD. As far as the 3mm, that is referring to the spondylolisthesis and not the disc bulges. But it is nice to know of someone else who also has issues at c2-c3.
    My MRI says the worser of the 2 disc bulges is 5mm. I am not really sure if that is considered a large protrusion or not. Yes, i have definetly noticed a trend when talking to doctors. It seems that because I am young they don't take me as seriously and think I can't be in that much pain.

    I suspected as much about the EMG. I have had my reflexes tested and seem to have exaggerated reflexes in both arms and legs.
  • The "mm" means millimeters. He is guessing that the amount of slippage on the disc in about 3 millimeters. The problem is that this cannot be measures accurately except by computer-assisted mensuration analysis of flexion and extension x-rays. It is important to have this evaluation because the AMA has strict guidelines for measuring accurately, and strict thresholds for the amount measured being rated as an impairment. 1 mm or less is not a problem. 1-3.5 mm is an abnormal amount of slippage that can be treated with chiropractic manipulation. Greater than 3.5mm is a permanently ratable condition, and can be serious. Ask your doctor about Computerized Radiographic Mensuration Analysis.
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