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Welcome to the board. I am surprised you only have pain in the left leg, that it only goes as far as the knee and that you only have a "dull" pain.

Your symptoms are coming from what is called a spondylolisthesis. This is where the vertebra slips over the top of the adjacent vertebra. On imaging of a normal spine, the edge of the bones (vertebrae) line up...but with a spondylolisthesis, you will see an "indentation." For diagnostic purposes it is labeled Grade 1 which is a 1-25% slippage, Grade 2 which is 26-50%, Grade 3, 51-75% and Grade 4 is 76-100%. Grade 1 and 2 are considered mild or not that much and may or may not require attention, depending on the patient's symptoms.

The issue with a spondylolisthesis is when it creates an instability, which allows that segment of the spine to shift more than it should. Sometimes a spinal nerve ends up getting "pinched" when this occurs. In your case the spondy is at L5-S1 segment and the L5 nerve is most likely getting caught up in it. You can look at a dermatome map to see what area of the leg this nerve innervates. Often with a spondy, the pain runs down into the foot and may cause tingling and/or numbness.

In addition the disc at this level is bulging out of the disc space and encroaching into the foraminal openings. The foramen is an opening located at each pair of vertebrae that allows the spinal nerve to exit the spine as it goes out to innervates a particular part of the body. This is a small opening that gets clogged up when something presses into it or grows within or into it as in the case of a bone spur or an enlarging facet joint. When this happens the opening is narrowed. This process is called stenosis.

When there is severe stenosis, the nerves at that level end up getting pinched/squished, compressed. This pain can be felt at the site in the back or anywhere along the path of the nerve...what we think of the radiating pain like the pain that runs down the back of the leg.

In your report, the stenosis is rated to be severe on the left and moderately severe on the left. This means that if you look at the imaging, you will barely see an opening in the foramina at this level. This is why I'm surprised you aren't in more pain than you indicate!. The good news is that the spondylolisthesis is stable. That makes treatment easier and often means it won't get worse.

If the spine surgeon ordered the MRI, you should have a follow up appointment where you will get an accurate diagnosis and plan for treatment. I suspect this will be a course of physical therapy, oral medications for pain and inflammation and perhaps a series of epidural steroid injections for the same purpose.

If your pain becomes debilitating and you find you cannot stand or walk for very long, surgery can be done to clean out the foraminal openings to decompress the nerves.

One caveat which I always mention to those with lower lumbar problems: if you suddenly develop muscle weakness as in a drop foot or bladder or bowel issues such as sudden incontinence, seek medical help immediately. This is a sign of "cauda equina syndrome" which is a serious compression of the bundle of nerves in the central canal that can cause permanent nerve damage if not resolved quickly.
Since I didn't see the MRI and the report doesn't mention if there is a pars defect that caused the spondylolisthesis, what I am about to say may not apply to you...so I mention it just so you are aware of some possible implications....

The primary problem with a spondylolisthesis is the potential for it to continue to slip. Since we know that any jarring movement is hard on the spine, I would assume that the repetitious footfalls of running would tend to aggravate the situation. Your spondy is stable at the moment...and you would like to keep it that way! Otherwise you will be looking at a fusion. There are currently no other options....live with it, or if it becomes unbearable, have the surgery.
The X-RAY states

Bilateral pars defects at L5 level.


[QUOTE=teteri66;5429529]Since I didn't see the MRI and the report doesn't mention if there is a pars defect that caused the spondylolisthesis, what I am about to say may not apply to you...so I mention it just so you are aware of some possible implications....

The primary problem with a spondylolisthesis is the potential for it to continue to slip. Since we know that any jarring movement is hard on the spine, I would assume that the repetitious footfalls of running would tend to aggravate the situation. Your spondy is stable at the moment...and you would like to keep it that way! Otherwise you will be looking at a fusion. There are currently no other options....live with it, or if it becomes unbearable, have the surgery.[/QUOTE]





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