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Back Problems Message Board


Back Problems Board Index


Welcome to the board. You have a situation in your lower back that creates instability in that lowest lumbar segment. A spondylolisthesis is where one vertebra (a bone of the spine) slips over the top of the adjacent vertebra. When you look at a picture of the spine you will notice the edges of the vertebral bones look evenly aligned. With a spondylolisthesis, the bones will look indented, like you'd draw a stair step. It is graded from 1 to IV with grade 1 meaning there is a 1-25% slippage. Grade 1 is the least severe of the four grades. However, if it is unstable, the bones are actually moving or can move and when this happens, a spinal nerve can get caught up in this movement. It can result in a nerve getting pinched, and unpinched, depending on how you move.

I had the very same thing, but one level up, at L4-5. I was told that the only way to resolve this problem is through surgery. There was nothing else that would help. However, the timing of the surgery was up to me. When I couldn't deal with the symptoms any more, I would elect to have the surgery.

I will close for now because I have an appointment in a few minutes. I will finish this when I return! Sorry for the delay.
Let me start with a couple basics just in case you aren't familiar with the jargon! The spine is divided into four sections: cervical, thoracic, lumbar and sacral. Each section has a specific number of vertebra that are numbered...in the lumbar it is L1 through L5. The bones are separated by a soft, gelatinous cushion called the intervertebral disc, more commonly called "disc." The L4-L5 disc is located between the Lumbar 4 and Lumbar 5 vertebrae. The L5-S1 disc is located between the last lumbar and first sacral vertebrae.

With a spondylolisthesis, the L5 vertebra is slipping across the S1 vertebra. You may find that this causes your pain and symptoms to move around. I remember I usually had pain in my right leg, but one day I went into PT complaining of my left leg hurting...and that continued for six months. Sometimes it will cause symptoms in both legs.

You need to pay attention to symptoms with a lower lumbar issue such as yours. If you develop sudden symptoms with bowel or bladder, or sudden muscle weakness such as a foot drop ( where the ankle reflex suddenly stops working and you drag the foot, you will want to get medical attention ASAP. Call your doctor or go to the emergency room. It could be a symptom of "cauda equina syndrome."

Cauda equina syndrome occurs when the nerve roots in the lumbar spine are compressed, cutting off sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage. This is one of the few actual medical emergencies that can occur in the spine. Everything else, while painful, is not a true emergency!

In addition to the spondylolisthesis, there are some degenerative changes going on. The MRI refers to "foraminal narrowing." The foramen is an opening located at the edge of the vertebra that allowed the spinal nerve to exit the spine to go out to the area of the body it innervates. Sometimes this opening gets clogged up and the diameter of the opening is narrowed. This results in the nerve getting "squished" or compressed. In order for this space to be opened up again, sometimes surgery is necessary. You will notice that there is some blockage on both the left and right side, with it being worse on the right side.

"Spondylotic changes" refer to the degenerative changes that are going on at this L5-S1 segment...to the disc, which is affected by the spondylolisthesis, the joint and the narrowing of the foramina at this level.

Hope this helps.





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