[hmrhded]

#6688

I guess what i’m trying to say , is that i went into surgery to correct my L5/S1 spondylolisthesis and it was not corrected. My L5/S1 pain may have been reduced , but now the L4/L5 pain is more noticable. As you noted from mri and x-rays , I probably needed a double fusion.Is this still possible?

[Donald Corenman, MD, DC]

#6697

The goal of L5-S1 spondylolisthesis surgery is not to reduce the slip of L5 on S1 but to decompress the nerves and fuse the L5 vertebra to the sacrum. Reduction of the slip can cause stretch of the L5 nerve roots and dysfunction of the nerves leading to foot drop. This is why full reduction of the slip is generally not recommended.

I cannot comment regarding the fusion to L5 and not to L4. Normally, with a posterior only fusion, fusion to L4 is common but not essential.

If you develop a non-fusion (pseudoarthosis), this can be repaired with further surgery.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[hmrhded]

#6710

Dr Corenman
Thank you so much for your website and forum!

I guess that i misunderstood the goal of the operation. I thought restoring the disk height and eliminating the spondylolisthesis , would create more “room and less stress” on the nerve roots.

[Donald Corenman, MD, DC]

#6715

You are correct, The goal of isthmic spondylolisthesis surgery is to restore the disc height and remove the bone spurs to make more room for the L5 nerve roots. Your only misconception is that “reducing the slip” or moving the L5 vertebra back to its normal position would improve the health of the nerves.

This slip has typically been present for some years prior to the need for surgery. The anterior malposition of L5 has allowed the L5 nerves to actually shorten over this period of time.

An attempt to push the L5 vertebra back to its “normal” position can stretch these nerve roots and can cause malfunction. This can lead to foot drop and other leg weakness. The general current surgical plan thinking with a slip is to allow the vertebra to “drift back” somewhat but not fully reduce so as to reduce the strain on the nerve roots.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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