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  • hmrhded
    Member
    Post count: 9

    Dr. Corenman,
    I have been suffering from a L-5/S-1 spondylolithesis for 32 years.In the beginning i tried physical therapy , lumbar stabilization cast , cortisone injections, and anything else the orthopedic doctor suggested.The doctor left the surgery option up to me. So i learned to live with the pain and discomfort.
    In the last two years the pain and stiffness in my back has gotten worse.I went to a new ortho doctor last year and had new x-rays taken.The spondylolithesis is still there,but my disc is gone or least smashed down to near nothing.My body also has formed bone spurs from L-5 to S-1 to help stablize the slippage. I think that a MRI would be in order, the doctor thinks injections are the answer.
    What’s your opinion?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    The treatment answer is based upon how you are functioning with your spondylolisthesis. If you can tolerate the pain and the disorder does not cause significant impairment (you can participate in all the activities you desire), the you do not need surgery. That is considering that you do not have motor weakness from compression of the L5 nerve.

    If you have impairment that you cannot live with or you have motor weakness, you most likely need to consider surgery. If you are not sure or are on the fence about surgery, an epidural injection can be helpful for two reasons. First- the epidural can give you some relief and if lucky, the effects may last 2-6 months. Second is that if you obtain good but temporary relief for a short period of days, relief will help you understand what the pain is doing to your life and you may decide to undergo surgery with that goal in mind.

    Dr. Corenman

    hmrhded
    Member
    Post count: 9

    Dr Corneman, I will try to make a long story short.I requested a MRI of my back be taken.Here is the report for the lumbar region.
    1. Grade 2 spondylolisthesis at L5-S1 secondary to bilateral L5 pars defects. Moderate central canal narrowing is seen with high-grade bilateral neural foraminal stenosis.
    2. Broad-based, shallow central disc herniation at L4-L5 contributing to moderate central canal narrowing at this level as well.
    I also had a thoracic MRI taken last week. Have not obtained the radiologist report yet.They were taken on different days. A bone scan was also taken because of three small meningioma’s around the T-3 area.
    Bone scan and blood test were negative for cancer.
    Can you give me an idea of what i should do next?
    Thank you

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    Well- 32 years of back pain is a long time to suffer. The question is how problematic is the pain? Is the pain intermittent or constant with exacerbations? Does the pain go down the legs? How severe is the pain on a 0-10 scale? What does the pain prevent you from doing? How does it affect your work life/ social life/ exercise life?

    32 years of 2/10 pain that doesn’t prevent outside activities is much different from 7/10 pain that prevents walking or any exercise.

    The isthmic spondylolisthesis (I presume) grade 2 is a substantial deformity and can cause significant pain, especially with severe bilateral foraminal stenosis. The degenerative changes above are typical in response to the slip below. Depending upon your symptom severity, you may be a candidate for a rehab program, a set of diagnostic and therapeutic epidurals or even surgery.

    Dr. Corenman

    hmrhded
    Member
    Post count: 9

    Dr. Corenman , I had a single injection epidural on 4-9-12,,,I waited three weeks ( no pain relief ) and called back in to their office. They have me scheduled for another injection later this month.
    In the mean time my family doctor gave me a referal to a neurosurgeon here in Iowa. I went there expecting to be treated with respect and concern about my spine.
    What i got was rude and overbearing treatment from the Dr.,,,he looked at the lumbar mri and then asked to heel walk and toe walk and to bendover and touch my toes. He stated that i walk fine and that i really didn’t need surgery,but , he would for me.
    Dr. if he attempts a PLIF at L-5 S-1 i am concerned about the two large bone growths or spurs that have grown between the two bodies on the anterior side. How could they be removed while doing a PLIF?

    Donald Corenman, MD, DC
    Moderator
    Post count: 8459

    I apologize for my colleagues behavior. I think there is no room for that type of attitude in this speciality.

    You need to go back to some basic questions. Do you have back pain or leg pain or both and by what percentage? Have you failed all forms of therapy? Is the pain incapacitating and intolerable?

    Let us assume you have incapacitating back pain with minimal leg pain. I will also assume you have read the section under “treatments”; “when is it time to have lower back surgery” and concur with the conclusions.

    The bone spurs in the front of the spine are generally no matter. They form from instability (enthesopathy- see website under lumbar DDD). Anterior bone spurs generally do not need to be removed. A fusion (I assume you mean a TLIF as PLIFs are not performed much anymore) might be the surgery you need as long as you have only one degenerative disc at L5-S1 and the L4-5 disc is normal (as well as all the ones above that).

    The anterior bone spurs will generally fade away after some years (Wolfe’s law) but if they don’t, you should not notice them.

    Dr. Corenman

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