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#31112

Hi,

I’m researching to find out if surgery is the only option to address persistent sciatic leg pain in my mother due to the L4 anterolisthesis – She is 80 yrs old, but morelike 70 in mobility. Her CAT scan showed a L4 nerve root issue (see below). Is there anything that could alleviate this such as an injection, or chiropractic manipulation? She carries midsection weight but otherwise average. She has been taking NSAIDs round the clock for months in order to cope. Thanks so much.

SUMMARY: There has been progressive anterolisthesis of L4 on L5 now grade 1-2, measuring up to 11mm with associated degenerative changes resulting in moderate central canal stenosis. Additionally, there is progressive foraminal stenosis particularly involving the left L4-5 formen impinging the exiting left L4 nerve root.

FINDINGS:
Five lumbar-type vertebrae are present. There is grade 1 anterolisthesis of L4 and L5 by approximately 11mm, secondary to underlying degenerative facet arthropathy. The vertebral body heights are maintained. No aggressive osseous abnormalities are seen.

L1-2: There is no significant disc bulge, central canal stenosis or foraminal stenosis.

L2-3: Mild broad-based posterior disc bulging is present slightly effacing the anterior thecal sac. Some disc content does extend into the neural foramen left greater than right, but without significant foraminal or central canal stenosis. Degenerative facet changes are present.

L3-4: Mild broad-based posterior disc bulging is present effacing the thecal sac. There is slight hypertrophy of the ligamentum flavum and degenerative facet arthropathy right greater than left. Some disc content does extend into the neural foramen, though without significant foraminal stenosis or central canal stenosis.

L4-5: There is grade 1-2 anterolisthesis of L4 on L5 secondary to advanced degenerative facet changes. There is secondary moderately large broad-based posterior disc bulging combined with ligamentum flavum hypertrophy and facet arthropathy which does result in a moderate central canal stenosis at this level. Disc content extends into the neural foramen bilaterally, which combined with the degree of malalignment which abuts and impinges the exiting left L4 nerve root within the neural foramen. There is mild narrowing of the right neural foramen, but without impingement.

L5-S1: There is a small posterior disc bulge associated with focal calcification of the central posterior disc. This does marginally abut the thecal sac and origin of the S1 nerve roots, though without convincing impingement. There is slight narrowing of the right neural foramen marginally abutting the exiting right L5 nerve root without impingement.

[Donald Corenman, MD, DC]

#31198

Your mother has a degenerative spondylolisthesis, a significant slip at L4-5 with associated foraminal stenosis. This condition can be quite debilitating. Injections can be helpful in the short term but she probably needs surgery. See https://neckandback.com/conditions/degenerative-spondylolisthesis-or-spondlylolysthesis/ and https://neckandback.com/conditions/foraminal-collapse-lumbar-spine/

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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