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Back Problems Message Board


Back Problems Board Index


One thing I didn't learn until well after my first lumbar surgery was there is a big difference in physical therapists. I think we have all been given a standard sheet of exercises to do for back pain. Usually they are stick figures with minimal instruction, but they look simple to do.

I started out like most people: I went to my family doctor/PCP with my complaint of sciatic pain. I went back several times before he took my complaints even slightly seriously. He sent me for a course of physical therapy where I was given the sheets of exercises....at some point I convinced him to do more so he ordered a MRI. He looked at it and told me that my MRI was perfectly normal for someone my age. My sciatic pain was unchanged and he finally got tired of hearing me complain, so he sent me to a spine specialist who he termed "conservative" (meaning he never did surgery unless it was absolutely necessary).

Imagine my shock when after about two minutes with the orthopedic spine surgeon, he told me I needed a spinal fusion. I went from thinking everything was fine to being told I needed a fusion...which at the time sounded like the most extreme thing imaginable. My issue was the spondylolisthesis that I had at L4-L5....the doctor told me it wasn't anything I needed to have fixed, but if it started causing problems, the only procedure that would fix it was a fusion.

Pebble gave you a definition...but in simple terms, retrolisthesis just describes the description that the vertebra is slipping (anterior or posterior)--the overall disease condition is called spondylolisthesis and it is a situation where one vertebra slips over the top of the adjacent vertebra. It occurs most frequently at L4-L5, followed by L5-S1. There are several causes for it which I won't go into here, but I will mention that it can arise in young people who spent a lot of their teens doing activities that require the spine to be in extension -- things like diving, gymnastics, dance, or in a contact sport like football and sometimes soccer.

Your retrolisthesis is described as mild, which would translate to a Grade 1
(graded from 1-4). In radiology language there are specific adjectives that are used to describe the severity of an issue: minimal, mild, moderate and severe. So, in your case, this is probably not causing you much of a problem and probably is not contributing to your pain.

The thing is...depending on what exercises you were given, it could be making your pain worse. If anything is done with your back bending backward (in extension) it is BAD for your retrolisthesis. You should avoid doing anything that requires you to arch your spine -- this includes swimming on your stomach, lying or sleeping on your stomach, etc.

The stenosis is not affecting the spinal fluid. It may be pressing into the central canal, but it doesn't affect any fluid. The danger comes from the nerve becoming so compressed that it cannot function normally. If you develop weakness in a muscle, like foot drop, or numbness, it is a sign that the nerve is badly compressed.

This pressing into the central canal is what is causing you to feel pain when standing or sitting, and relief when you lie down. Once it is decompressed, most people get almost instant relief. Of course the nerve may be somewhat damaged, so it can take awhile for all the pain to go away.
[QUOTE=teteri66;5084464]One thing I didn't learn until well after my first lumbar surgery was there is a big difference in physical therapists. I think we have all been given a standard sheet of exercises to do for back pain. Usually they are stick figures with minimal instruction, but they look simple to do.

I started out like most people: I went to my family doctor/PCP with my complaint of sciatic pain. I went back several times before he took my complaints even slightly seriously. He sent me for a course of physical therapy where I was given the sheets of exercises....at some point I convinced him to do more so he ordered a MRI. He looked at it and told me that my MRI was perfectly normal for someone my age. My sciatic pain was unchanged and he finally got tired of hearing me complain, so he sent me to a spine specialist who he termed "conservative" (meaning he never did surgery unless it was absolutely necessary).

Imagine my shock when after about two minutes with the orthopedic spine surgeon, he told me I needed a spinal fusion. I went from thinking everything was fine to being told I needed a fusion...which at the time sounded like the most extreme thing imaginable. My issue was the spondylolisthesis that I had at L4-L5....the doctor told me it wasn't anything I needed to have fixed, but if it started causing problems, the only procedure that would fix it was a fusion.

Pebble gave you a definition...but in simple terms, retrolisthesis just describes the description that the vertebra is slipping (anterior or posterior)--the overall disease condition is called spondylolisthesis and it is a situation where one vertebra slips over the top of the adjacent vertebra. It occurs most frequently at L4-L5, followed by L5-S1. There are several causes for it which I won't go into here, but I will mention that it can arise in young people who spent a lot of their teens doing activities that require the spine to be in extension -- things like diving, gymnastics, dance, or in a contact sport like football and sometimes soccer.

Your retrolisthesis is described as mild, which would translate to a Grade 1
(graded from 1-4). In radiology language there are specific adjectives that are used to describe the severity of an issue: minimal, mild, moderate and severe. So, in your case, this is probably not causing you much of a problem and probably is not contributing to your pain.

The thing is...depending on what exercises you were given, it could be making your pain worse. If anything is done with your back bending backward (in extension) it is BAD for your retrolisthesis. You should avoid doing anything that requires you to arch your spine -- this includes swimming on your stomach, lying or sleeping on your stomach, etc.

The stenosis is not affecting the spinal fluid. It may be pressing into the central canal, but it doesn't affect any fluid. The danger comes from the nerve becoming so compressed that it cannot function normally. If you develop weakness in a muscle, like foot drop, or numbness, it is a sign that the nerve is badly compressed.

This pressing into the central canal is what is causing you to feel pain when standing or sitting, and relief when you lie down. Once it is decompressed, most people get almost instant relief. Of course the nerve may be somewhat damaged, so it can take awhile for all the pain to go away.[/QUOTE]

Thanks a ton for your response. Your situation sounds exactly like mine: a primary care physician who wouldn't believe my pain was anything more than some muscle tightness. Your situation with your spine doctor is what I fear: being told I need immediate surgery. Like I said before, I can do nothing but hope that I don't have severe, permanent damage because my primary care doctor wouldn't listen to my requests for an MRI.

So in regards to exercise and stretching, do you think I should just take it easy and not do anything strenuous? I know that seems like a dumb question, but I was wondering what you did in your situation.

I'm glad to hear that my mild retrolisthesis isn't THAT big of a deal. Now I can focus on the herniated disc, severe spinal stenosis, and mild facet arthropathy (which I still don't know much about). It sucks having a TON of questions that I can't get answered for an indeterminate amount of time.

Would you have any thoughts on my MRI pics? I know it's a long shot, but I'm just trying to gather as much info as possible.





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