Spondylolisthesis means one vertebra has slipped forward on the vertebra below. When it shows up on imaging after a car accident, the first question is whether it was already there. Often it was, because degenerative spondylolisthesis develops over years. Sometimes the question is whether a slip that was stable before the crash now moves more than it should. Imaging can answer parts of both questions for patients in Charlotte, and it is limited in specific ways.
Supine MRI Can Miss It
At OrthoCarolina in Charlotte, 416 patients with degenerative lumbar conditions had both supine MRI and standing X-rays. Of 109 spondylolisthesis levels seen on the standing films, 31, or 28%, were not visible on the MRI (Segebarth, J Spinal Disord Tech 2015). Lying down can let the slip reduce. A patient whose only imaging is a supine MRI may have a slip nobody has seen.
The same study found that flexion and extension X-rays added nothing over a single standing lateral film for detecting the slip. A standing film is enough to find it.
Is It Linked to Pain?
In a meta-analysis of adults 50 or younger, spondylolisthesis was not significantly more common in people with low back pain than in people without it (Brinjikji, AJNR 2015 meta-analysis). Spondylolysis, a defect in the bony bridge at the back of the vertebra that can lead to a slip, was, with an odds ratio of 5.06. Finding a slip on imaging does not, by itself, explain a patient's pain.
New or Pre-Existing
A single post-crash image cannot date a slip. Prior imaging can. One retrospective case series of 41 patients with cervical X-rays before and after a collision found that four, about 10%, developed segmental translations after the crash that were just under the 3.5 mm instability threshold (Haas, Diagnostics 2024). That series had no control group, its authors include Chiropractic Biophysics NonProfit and PostureCo affiliations, and it covered the neck, not the low back. It shows that the before-and-after comparison is possible and informative.
When Motion Matters
A pre-existing slip and an unstable slip are different findings. The AMA Guides to the Evaluation of Permanent Impairment rate loss of motion segment integrity on flexion and extension X-rays, measuring how far a segment translates between the two positions. A slip that was present before the crash but now moves past the AMA threshold is a different finding from a slip that was present and still moves normally. Detecting the slip needs only a standing film. Measuring whether it is unstable needs motion films.
In practice, I ask every patient with a slip for prior imaging, take a standing lateral film, and add flexion and extension films when the exam suggests the segment is a pain source.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read Dr. Justin Dick's published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient.
Frequently Asked Questions
What is spondylolisthesis?
Spondylolisthesis is a forward slip of one vertebra on the vertebra below. Degenerative spondylolisthesis develops over years and is often present before a car accident.
Can an MRI miss spondylolisthesis?
Yes. In a Charlotte cohort, supine MRI missed 28% of spondylolisthesis levels seen on standing X-rays (Segebarth, J Spinal Disord Tech 2015).
Does spondylolisthesis cause back pain?
Not necessarily. In adults 50 or younger, spondylolisthesis was not significantly associated with low back pain in a meta-analysis, though spondylolysis was (Brinjikji, AJNR 2015 meta-analysis).
Can a car accident cause spondylolisthesis?
A single post-crash image cannot show whether a slip is new. Prior imaging can. A slip that existed before may also become unstable, which is measured on flexion and extension X-rays.
How does Dr. Justin Dick evaluate a spondylolisthesis after a crash?
Dr. Justin Dick in Charlotte, NC requests prior imaging, takes a standing lateral X-ray, and adds flexion and extension films when the exam points to the slipped segment.
Where can I get a spondylolisthesis evaluated after a car accident in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), sees car accident patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Segebarth B, Kurd MF, Haug PH, Davis R. Routine upright imaging for evaluating degenerative lumbar stenosis: incidence of degenerative spondylolisthesis missed on supine MRI. J Spinal Disord Tech. 2015;28(10):394-397. PMID 25353204. LinkEvidence tier: Retrospective cohort
- Brinjikji W, Diehn FE, Jarvik JG, et al. MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2015;36(12):2394-2399. PMID 26359154. LinkEvidence tier: Systematic review and meta-analysis
- Haas JW, Oakley PA, Ferrantelli JR, Katz EA, Moustafa IM, Harrison DE. Abnormal static sagittal cervical curvatures following motor vehicle collisions: a retrospective case series of 41 patients before and after a crash exposure. Diagnostics (Basel). 2024;14(9):957. PMID 38732372. LinkEvidence tier: Retrospective case series; authors include CBP NonProfit and PostureCo affiliations
- American Medical Association. Guides to the Evaluation of Permanent Impairment, Fourth, Fifth, and Sixth Editions.Evidence tier: Expert consensus (impairment rating guideline)
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Dr. Justin Dick's research
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
- Questions and answers
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Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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