Cervical and thoracic degenerative spinal instability

Although not as common as lumbar degenerative instability, instability in the cervical and thoracic spines, when present, typically manifests as a spondylolisthesis, or the forward translation of the cephalad vertebra on the caudal one. Cervical degenerative spondylolisthesis can occur at C1–2 or subaxially. It can result in a spectrum of symptoms ranging from axial neck pain, atlantoaxial or subaxial instability, radiculopathy and myelopathy. The pattern and severity of cord compression as well as the degree of instability determine the surgical approach. Bone quality available for fixation must also be considered. Thoracic degenerative spondylolisthesis is relatively rare due to the inherit stability in this region. Generally a posterior fusion with instrumentation is recommended when decompressing a thoracic level with associated spondylolisthesis, especially in cases where there is dynamic change in the spondylolisthesis on upright or flexion/extension radiographs.