In congenital cervical spondylolisthesis, which level is most commonly affected?

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Congenital cervical spondylolisthesis arises when a developmental fault in the vertebrae allows one vertebra to slip forward on the one below. The level most prone to this slip is the mid-to-lower cervical spine where there is the greatest mobility and a facet joint orientation that permits more anterior shear during motion. At around C6, these factors combine to make forward translation more likely when a segmentation defect is present, so slippage tends to occur there (often over the inferior vertebra, such as C7). In contrast, the upper cervical region (C1–C2) is held very stable by robust bony and ligamentous structures, making listhesis less common there, and the very lowest cervical level is less susceptible due to its different biomechanics. Hence, C6 is the level most commonly affected.