[Shipra S]

#31554

Hello Doctor,
I was recently diagnosed with dysplastic spondylolistesis. I had sciatica symptoms from past 2 years but dint know the root cause of it. I have my MRI report as:
Exaggerated lumbarlordosis is noted.
Grade I anterolisthesis of L5 over S1 vertebrae is noted with facetal joint arthropathy.
Degenerative endplate changes noted at L5-S1 level.
Rest of the vertebral bodies show normal marrow signal characteristics
No evidence of osteolysis / osteosclerosis.
No evidence of spondylolysis.
Facetal arthropathy is noted at L5-S1 level.
Conus is normal in size and signal intensity.
No extradural/intradural/ intramedullary mass lesion.
No pre or para vertebral soft tissue mass lesion seen.
AP spinal canal dimension at the Pedicular levels are as follows:
L1 level : 1. 81 cms
L2 level : 1. 89 cms
L3 level : 1. 69 cms
L4 level : 1. 76 cms
L5 level : 1. 23 cms
Disc desiccation is noted at L5-S1 level as evidenced by loss of normal hyperintensity on T2 Wt images
L5-S1 disc shows pseudo-posterior bulge with central and left paracentral annular tear and protrusion
indenting thecal sac impinging on bilateral traversing S1 nerve roots compromising neural foramina
and spinal canal.
Rest of the intervertebral discs are normal.
Both sacro-iliac joints are normal
I have partial loss of sensation below buttocks in left leg and right leg sciatica with heel pain.
I also have to strain while urinating and have recurrent UTI.
Please suggest me if surgery is needed. I also want to become pregnant. Will pregnancy affect me and cause loss if bladder and bowel?
Please help me

[Donald Corenman, MD, DC]

#31577

I am unclear if you have a dysplastic variant of isthmic spondylolisthesis or a degenerative spondylolisthesis.This does not make a difference with whether you need surgery (probably). The difference generally is in the nerve root being affected. With an isthmic spondylolisthesis, the nerve root affected is typically L5 and with the degenerative type, it would be the S1 root. The surgery is generally the same type (TLIF) regardless of the root cause of your slip.

“Please suggest me if surgery is needed”. Probably. With a grade one slip, compression of the S1 nerve roots with 2 years of sciatic pain and a failing L5-S1 disc (“Disc desiccation is noted at L5-S1 level as evidenced by loss of normal hyperintensity on T2 Wt images L5-S1 disc shows pseudo-posterior bulge with central and left paracentral annular tear and protrusion
indenting thecal sac impinging on bilateral traversing S1 nerve roots compromising neural foramina and spinal canal”). You can try epidural steroid injections which should buy you some time.

“I also want to become pregnant. Will pregnancy affect me and cause loss if bladder and bowel”? You probably won’t have bowel and bladder problems with pregnancy but unfortunately, your back pain and leg pain might become worse with the extra weight and the hormone relaxin present.

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.

[Shipra S]

#31580

Thank you so much for acknowledging my concern Doctor. But how do we differentiate between isthmic and degenerative spondylolistesis?So, the only option left is surgery? As per the report it say s1 nerve root impingement.

This is the link of my MRI and xray.

[Donald Corenman, MD, DC]

#31582

Sorry but can’t leave hyperlinks that are not know in the thread.

This sentence is a clue “Grade I anterolisthesis of L5 over S1 vertebrae is noted with facetal joint arthropathy”. In an isthmic spondylolisthesis, the facet joints are “broken off” so could not become degenerative (arthropathy). Only with the degenerative spondylolisthesis can facet joints wear out, so most likely you have a degenerative spondylolisthesis. This would fit with the S1 nerve too.

You can try physical therapy and epidural steroid injections and buy some time but a new X-ray or MRI in one year will look no better than what you have now and possibly worse.

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.

[Shipra S]

#31587

Thank you

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