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Back Problems Message Board

Back Problems Board Index

Welcome to the board. I can give you some general impressions about your radiology report based on my experiences as a fellow back pain sufferer, but remember, we are not physicians and most of us have no professional medical training!

Be sure that you are seeing a fellowship-trained spine specialist. This can be either an orthopedic spine specialist or a neurosurgeon who devote their practice to patients with back or neck problems. (Some orthos treat the spine, but also work on joints, set bones, etc. You want one who specializes in the spine, only).

From the description of your symptoms and what is noted in the MRI report, your "issues" seem fairly straight forward. Unfortunately, unlike many problems with the spine, yours are not going to be resolved with exercise and most conservative treatments.

The two things that are causing you problems are the stenosis and the spondylolisthesis. When a patient with these issues can no longer deal with the pain, it is usually time for surgery. The spondylolisthesis you have at L5-S1 has increased since your previous MRI. This is a slippage where one vertebra slides over the top of the adjacent vertebra. When you look at your MRI, you will be able to see that the edges of the vertebra do not line up at this segment.

Spondylolisthesis results in lower back pain. Sometimes a spondylolisthesis puts additional pressure on the surrounding nerves resulting in radicular pain that you feel in the buttocks and/or running down the leg. It also causes that segment of the spine to become unstable. Usually bending backwards will cause pain, while bending forward feels somewhat better.

This condition is graded from I to IV. Grade 2 spondy means that the slippage is from 25% to 50%. Usually grade I and 2 spondy do not necessarily require surgery, unless the pain is such that it is no longer tolerable. As you have found out, it can continue to worsen. Sometimes this happens quickly and sometimes people have a grade 1 or 2 for the rest of their lives.

The other condition, stenosis, is a narrowing. It can occur in the central canal or in the openings that are a part of each vertebral segment that are used by the spinal nerves to exit the spine. This "opening" is called a foramen (foramina is the plural). When this opening is blocked, there is less or little room for the nerve and the result is that the nerve ends up getting "pinched" or compressed. At L5-S1, these nerves supply movement to the ankle reflex and sensation to the foot and the outside of the leg. Pain can also radiate into the groin, buttock and hip. The nerve pain can take on all sorts of characteristics: sharp, stabbing, electrical, numbing, feeling of water running down the leg, etc.

Surgery is often performed for stenosis...kind of a "roto-rooter" thing, where they go in and clean out these openings, which are often clogged with little osteophytes, which are a type of bony overgrowth. It is often done in conjunction with another spinal procedure. I am not aware of another way to open up these spaces.

I'm not sure why you feel best when running or golfing. The twisting and impact when you strike the ball are hard on the spine. Running puts additional stress on the discs, and the impact of each footfall is jarring. Your spine surgeon can advise you on this. Also having to spend so much time in the car is not good...but I know, you do what you have to do!

I had moderate symptoms when I first went to a doctor. I wasted a year with my internist who kept telling me my MRI was normal "for someone my age." I was about 52 at the time, as I recall. Finally I think he got tired of my complaints so he sent me to a spine surgeon who he described as very conservative (meaning: he will only recommend surgery if absolutely necessary). I went in believing he would tell me that there was nothing going on, so I was shocked when the first words out of his mouth were "fusion." But he also explained that very few spine surgeries are ever considered a medical emergency, and that I could wait. He said there would probably come a day when the pain was taking away too much of my normal activity and I would decide it was time to have the surgery. And that is what happened.

I waited for several years before having my first surgery. But in that time, my pain increased to the point that I could not stand for more than a couple minutes at a time, and I couldn't walk more than a very short block. I was lucky in that the pain was relieved as soon as I sat or lay down. Otherwise, it would have been intolerable.

I would guess that you will be able to put off surgery as well, perhaps for a long time. But I'm afraid there are not too many conservative measures that are going to help a lot. Keeping your core and back muscles strong is important. Corticosteroid injections may ease the pain for a short while. However, nothing is going to open up those foramina and allow for more space for the nerves, and nothing will stabilize the L5-S1 segment other than surgery.

If you can put off surgery, there is always the hope that new, less invasive technology will evolve and you can avoid a fusion.

Please let us know what the surgeon says and how he plans to treat you. Feel free to post with any comments or questions.
They can do a procedure called a foraminotomy which is as it sounds. The surgeon goes in and cleans out the foramen that are clogged and causing nerve compression. The foramen are easily seen on MRI. On one of mine, there was just a pin-prick of an opening, and the technician and doctor were surprised I could even walk at all, as the nerve was so compressed.

My first fusion was successful in terms of the doctor accomplishing what he had planned. I healed well, but the pain never resolved. After that another surgeon performed a foraminotomy to open up the L5 foramen, but ultimately, it only provided relief for a short while. It was an easy surgery. I did stay in hospital overnight, but came home the next morning and baked brownies....

It ultimately turned out that I still had some instability in my lower lumbar spine that was not visible on any imaging that I'd had. So I had more surgery and am now fine.

One thing to consider is that if you are ultimately going to end up with a fusion, it may be wiser to do everything at once. Every time a patient has spine surgery, the risk of infection increases. But that is a minor problem compared to the issue of scar tissue. Every surgery produces scar tissue, and some people's bodies manufacture more than others. When you are going in to operate on the same location several times, this can become an issue. This would be something to discuss with your surgeon.

Also when there is a spondylolisthesis, not every surgeon will consider doing it with a minimally invasive technique. I don't know if it depends on the patient's "issues," the surgeon's preferences, or what...but I do know of surgeons who will usually handle this situation with an open surgery. I know in my situation, I think I went to 8 different orthos or neurosurgeons for consultations before my first surgery. (I kept thinking there must be someone who would do something other than a fusion!!) Everyone recommended fusion, and no one said they would do it minimally I was disappointed.

I found it is best to pick the surgeon and trust his advice rather than picking a procedure and then finding a surgeon who will perform it!! Don't let the promises of newer technologies woo you. Be sure to thoroughly investigate your particular issues and the surgeons you consult with. You don't want to end up being a guinea pig.

You will probably find from talking with family and friends that everyone knows someone who had back surgery and they are only too eager to tell you all about it. Usually what you will learn is a bit removed from the factual reality! So take it into consideration, considering the source, and do your own research as much as possible. Word of mouth can be good for finding a spine specialist and choosing a hospital, but again, do your own investigating, too.

With the internet, it is now fairly easy to learn about a surgeon's background, whether there are lawsuits filed against him, whether he gets a check from a medical device manufacturer, etc.

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