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Hi Peppers,

I was diagnosed at 21 with a grade one spondy, thats only up to 25% slip and usually not a call for concern or syrgery unless there is associated nerve impingement which i had. I am now 24 with one failed fusion behind me. I am due for a second surgery in 6 weeks or so.

Ive researched a lot on this condition and ive also made a few very lengthy but well covered posts on the anatomy of the spondy. All you have to do if you want to check these out is to do a search on the topic within the healthboards site. The database will search for all topics on spondys and you can sift through them.

As you probably know a spondy is where one or more vertebrae have developed a weakness in the bony structures called 'facet joints' that attach one vertebrae to the one above and below. When these are weak or fracture and of course based on the curve of your spine, these vertebrae have a tendency to slip forward. I like to think of this a car on the edge of a cliff where the car is a vertebrae and the cliff is the rest of the spinal structure. A grade one is where the bonet of the car is over the edge of a cliff but all four wheels are still on land. A grade 2-3 is where the front wheels are off the edge of the cliff. A grade four is where the car is half off the cliff and a grade five is get out of the car now cause its going to fall!


Often spondys can be managed with regular exercise and some physio. If you're not a particularly active person you may never even know you have had it.

For those who have a problem with their spondy there are a number of avenues, before surgery is considered.

First, the current condition of the nerves surrounding the affected vertebrae are considered. I am not sure how much you know about the history of anatomy of a spondy but the spinal cord runs down from the brain to the L1. At each vertebrae from the top C1 down to the L5, little nerve roots run out the left and right sides of each of the vertebrae. These nerves then branch into smaller nerves that service those parts of the body around which the nerves have exited. I like to explain this like a freeway. The spinal cord is the main freeway. The overpasses on the freeway are the vertebrae and the exit and entry ramps are the nerve roots that take you off to smaller streets (bodily organs).
The tendency of the affected vertebrae to 'slip' affects the discs above and below (though usually only one disc is affected). When the disc is pulled with the 'slip' it may buldge or even rupture. This rupturing has the capacity to squash the nerve exiting at that vertbrae. If it gets squashed significantly enough you will begin to experience strange pain, more annoying aches than actual pain at first, and its often hard to explain to anyone exactly where you think the pain is. It's called reffered pain. It means the nerve is squashed up at the vertbrae but you may not feel it till half way down you leg (sagain depending on which vertebrae is effected. Someonetimes as the buldge in the disc becomes bad enough or the slip becomes worse (as in your case), the nerve slowly gets more and more squashed. This can lead to permanant damage meaning you may lose feeling in the leg. Nerve damage is considered a significant cause for surgery.

Secondly, the changes in x-rays over a period of time. The first thing a doctor will say to you is, yep you've got a spondy. Lots of people have spondys and dont even know it unless it worsens as yours has. Normally though they will say, have regular x-rays and come back if the pain worsens. We will see how it looks over time. In the mean time they will give you exercises to strengthen and gently stretch. They will advise regular exercise to keep your weight low so as your spine is not exposed to excess weight. They will also advise toning your abdominals which are the most important muscles as they protect the spine by wrapping a number of layers around the lumbar spine.

Thirdly, that conservative measures have been unsuccessful for a period of time. The doctor will prescribe treatments such as physiotherapy, hydrotherapy you might try massge, you might try gym work but these may all not work. It is then that surgery may also be considered.

The specialist that you see will depend largly on the kind of damage associated with your spondy but it is advisable to see a neurosurgeon as they really are the most appropriate specialists to deal with when there is nerve damage as its a very delicate area requiring special attention.

The fact that you were a grade 2 not long and are now a grade 4 signifies that the spondy is progressive and will most likely require surgery.

Hope this has been of some assistance to you

Brooke
[QUOTE=Brooke79]Hi Peppers,

I was diagnosed at 21 with a grade one spondy, thats only up to 25% slip and usually not a call for concern or syrgery unless there is associated nerve impingement which i had. I am now 24 with one failed fusion behind me. I am due for a second surgery in 6 weeks or so.

Ive researched a lot on this condition and ive also made a few very lengthy but well covered posts on the anatomy of the spondy. All you have to do if you want to check these out is to do a search on the topic within the healthboards site. The database will search for all topics on spondys and you can sift through them.

As you probably know a spondy is where one or more vertebrae have developed a weakness in the bony structures called 'facet joints' that attach one vertebrae to the one above and below. When these are weak or fracture and of course based on the curve of your spine, these vertebrae have a tendency to slip forward. I like to think of this a car on the edge of a cliff where the car is a vertebrae and the cliff is the rest of the spinal structure. A grade one is where the bonet of the car is over the edge of a cliff but all four wheels are still on land. A grade 2-3 is where the front wheels are off the edge of the cliff. A grade four is where the car is half off the cliff and a grade five is get out of the car now cause its going to fall!


Often spondys can be managed with regular exercise and some physio. If you're not a particularly active person you may never even know you have had it.

For those who have a problem with their spondy there are a number of avenues, before surgery is considered.

First, the current condition of the nerves surrounding the affected vertebrae are considered. I am not sure how much you know about the history of anatomy of a spondy but the spinal cord runs down from the brain to the L1. At each vertebrae from the top C1 down to the L5, little nerve roots run out the left and right sides of each of the vertebrae. These nerves then branch into smaller nerves that service those parts of the body around which the nerves have exited. I like to explain this like a freeway. The spinal cord is the main freeway. The overpasses on the freeway are the vertebrae and the exit and entry ramps are the nerve roots that take you off to smaller streets (bodily organs).
The tendency of the affected vertebrae to 'slip' affects the discs above and below (though usually only one disc is affected). When the disc is pulled with the 'slip' it may buldge or even rupture. This rupturing has the capacity to squash the nerve exiting at that vertbrae. If it gets squashed significantly enough you will begin to experience strange pain, more annoying aches than actual pain at first, and its often hard to explain to anyone exactly where you think the pain is. It's called reffered pain. It means the nerve is squashed up at the vertbrae but you may not feel it till half way down you leg (sagain depending on which vertebrae is effected. Someonetimes as the buldge in the disc becomes bad enough or the slip becomes worse (as in your case), the nerve slowly gets more and more squashed. This can lead to permanant damage meaning you may lose feeling in the leg. Nerve damage is considered a significant cause for surgery.

Secondly, the changes in x-rays over a period of time. The first thing a doctor will say to you is, yep you've got a spondy. Lots of people have spondys and dont even know it unless it worsens as yours has. Normally though they will say, have regular x-rays and come back if the pain worsens. We will see how it looks over time. In the mean time they will give you exercises to strengthen and gently stretch. They will advise regular exercise to keep your weight low so as your spine is not exposed to excess weight. They will also advise toning your abdominals which are the most important muscles as they protect the spine by wrapping a number of layers around the lumbar spine.

Thirdly, that conservative measures have been unsuccessful for a period of time. The doctor will prescribe treatments such as physiotherapy, hydrotherapy you might try massge, you might try gym work but these may all not work. It is then that surgery may also be considered.

The specialist that you see will depend largly on the kind of damage associated with your spondy but it is advisable to see a neurosurgeon as they really are the most appropriate specialists to deal with when there is nerve damage as its a very delicate area requiring special attention.

The fact that you were a grade 2 not long and are now a grade 4 signifies that the spondy is progressive and will most likely require surgery.

Hope this has been of some assistance to you

Brooke[/QUOTE]

Brooke, I am really sorry that your fusion failed. I have to disagree with your statement that a neurosurgeon is the best specialist for this type of problem. I would respectfully suggest an orthopedic surgeon who specializes in spondy and spinal reconstruction surgery. There is a new device which some of the cutting edge orthopods are using which greatly reduces the risk of nerve damage in spondylolisthesis reduction surgery. Orthopods, in my experience, are somewhat better at doing fusions. Given the extreme gravity of this condition, I would also suggest that it worth travelling to another city if necessary to get the right surgeon for this type of surgery.





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