Degenerative Spondylolisthesis of the Cervical Spine. A Long Term Follow-up Study

Methods: We reviewed the records of fifty-eight patients treated for degenerative cervical spondylolisthesis from 1974 to 2001. Fifty patients were followed for at least two years. Forty-five required operative treatment, while five were managed nonoperatively. The average follow-up was six years (range, two to twenty-four years). Thirty-eight patients presented with neck or occipital pain, eighteen with radiculopathy, and twenty were myelopathic. Patients presenting with myelopathy were classified according to the Nurick grading system. Seventy-one cervical levels demonstrated spondylolisthesis, with the mean degree being 4.03 mm (range, 2.0 to 7.0 mm). The most frequent level of involvement was between the fourth and fifth cervical vertebrae. In all cases there was radiographic evidence of facet degeneration, including joint erosion, remodeling and subluxation.

Results: Forty-two of forty-five patients achieved osseous fusion. All thirty-eight patients with neck pain reported improvement. At final follow-up, no patient had worsened neurologically. All twenty patients with myelopathy demonstrated improvement, with an average recovery of 1.5 Nurick grades. There was one reoperation for increased symptomatic spondylolisthesis at the cervicothoracic junction below a three-level fusion. Two additional patients required a second anterior procedure for symptomatic nonunion.

Conclusions: Degenerative spondylolisthesis of the cervical spine is a distinct entity. Neck pain, radiculopathy, and myelopathy are common presentations. Patients with mild symptoms can be successfully managed with conservative measures. In patients with more severe symptoms and/or evidence of neurological compression, anterior or posterior cervical decompression and arthrodesis appear to be effective ways to achieve neurological improvement and spinal stabilization.