Your question does require an understanding of your X-rays and MRI which cannot be done here. I can give you a general idea of what can happen.
The degenerative spondylolisthesis at L4-5 is somewhat common. When the facets fail and the L4 vertebra slips forward on L5- this narrows the canal. Many patients will then develop neurogenic claudication- pain in the buttocks and legs with standing and walking that improves with sitting. If you have severe stenosis or instability of the segment, sometimes decompression and fusion surgery is necessary to stabilize the segment and relieve the pressure on the nerve roots.
If you have substantial degenerative disc disease above that level, it may not matter. If your symptoms include significant back pain however, this may be a problem. Yes, a fusion of the L4-5 level can place some increased stress on L3-4 but the natural history of the L3-4 level without any fusion at L4-5 may still create problems in the future.
Unfortunately, many of the problems we have in our spines are genetically related. It is better in my opinion to leave a non-symptomatic degenerative segment alone than to include it in a surgery unless the segment can be predicted to cause problems in the future. Work on core strength and ergonomics after surgery as best you can to protect your back.
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.
