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  • vidhatad
    Member
    Post count: 6

    Hello Dr. Corenman,

    I have a particular case with all symptoms at the L5-S1. The MRI report says the following:

    1. Minimal Anterolisthesis of L5 over S1 with suspicious spondylolysis on right side (there is very little slip of L5 over S1 as seen on the MRI)
    2. Posterior pseudo bulge of L5-S1 disc is seen indenting the thecal sac
    3. Rest of intervertebral discs appear normal
    4. Mild facetal arthropathy is noted at L5-S1 level
    5. Lower end of spinal cord, cauda equina and filum terminale appear normal. No abnormal pre/ paraspinal soft tissue mass seen
    6. Screening images of spine reveal mild changes of cervical spine (DDD at C5-C6 and C6-C7; paracentral and lateral herniation at C6-C7 – 3 doctors described this as severe and suggested surgery; 1 suggested traction and rest – after nearly 1 month of rest there is no pain in my shoulders, back or right arm)

    After nearly 2 months of rest, I have had continued numbness on the right side of thigh (thing-knee joint). Alternatively, I also get cold feeling and sometimes feelings of an electric shock in the same region. Post the rest period, the doctors asked me to start physiotherapy exercises and try to return to normal life. I have been recommended neck/ shoulder and lower back strengthening exercises. The neck strengthening and back exercises involve some flexion and some expansion exercises.

    After doing the exercises for nearly 3 weeks now, lately I have started getting itching sensations in the right leg, as well as the left leg. And sometime when I sit in one place for more than 45 minutes to an hour, I believe I feel numb in my private parts. I also get a tingling sensation at time in the fingers of my left foot. Though both of these sensations go away after standing up and walking about for sometime or lying down. Also, lying down on my back gives me vibrations kind of sensation in areas of my right thigh.

    However, I do not have any other problems like major pain. I also keep checking my conditions for ankle movements and foot-drop, and have no problems there as well.

    I have a couple of questions:
    1. Do these increasing symptoms indicate worsening of my condition, especially at L5-S1 region?
    2. If so, what are my next options?
    3. Is my condition warranted for a fusion surgery?
    4. Does a fusion surgery at L5-S1 lead to degeneration of disc at the L4-L5 level?

    My apologies for the longish post – but am quite worried about my condition.

    Regards,
    Vidhata Deshpande

    vidhatad
    Member
    Post count: 6

    Hello Dr. Corenman.

    Since I wrote to you yesterday, some symptoms have changed/ increased. These are as below:

    1. three times since yesterday, I have noticed an electric shock like sensation near my saddle area.
    2. Also, I have had electric shock like pain in my left knee lateral side
    3. A burning sensation near my gluteal cleft

    What I am requesting from you is to understand what symptoms should I be most worried about or what would constitute a medical emergency?

    Thanking you in advance.

    Regards,
    Vidhata

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    There is nothing that you report in symptoms or imaging that appears to be an emergency. Your lower back most likely has an isthmic or degenerative spondylolisthesis at L5-S1 which is low grade and not compressing any neural structures (according to the report).

    Your neck has a disc hernation at C6-7 which might have been causing some left arm symptoms in the past but you have recovered from that and have no upper extremity symptoms now.

    The symptoms you have could be related to your spondylolisthesis but based upon the imaging report, I would agree that a good rehabilitation program would be beneficial. If these symptoms originate from your back, an epidural steroid injection might also be helpful.

    Dr. Corenman

    vidhatad
    Member
    Post count: 6

    Thank you for the response Dr. Corenman. It is indeed very helpful. Just a couple more questions:
    1. What are the chances that a degenerative spondylisthosis can deteriorate further and become unstable?
    2. While I am diligently doing all exercises for the back, from what I understand, flexion is bad for the Spondylisthesis and expansion is bad for the bulge? In any event, I have been given both in moderation. Should I continue with these?
    3. How many times, in your experience, does a degenerative Spondylisthesis require a surgery, especially considering a bulge in the disc?
    4. Last but not least, can somebody with my conditions remain surgery free for a long-time by just following Physiotherapy?

    Thank you for your response once again.

    Regards,
    Vidhata

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Degenerative spondylolistheses can degenerate further and become unstable but worrying about that is somewhat like worrying about getting hit by a meteor when you walk outside. It most likely will not happen but if it does, you will know it. Don’t waste your energy worrying about this possibility.

    Actually, the flexion is more of a problem for the disc bulge and extension is more problematic for the slip but again, don’t be too concerned about that. Core strengthening is the key to stabilizing the spine.

    I cannot tell you how many times a degenerative spondylolisthesis needs surgery as the population I see has enough symptoms to consider surgery. I have no doubts that there are many more walking around with this diagnosis who don’t even know it.

    Most patients with this diagnosis do not need surgery so the answer to your last question is yes.

    Dr. Corenman

    vidhatad
    Member
    Post count: 6

    Thank you Dr. Corenmon. Sorry for the delayed respopnse.

    Had a couple of questions on the L5-S1 bulge. Though this is currently not a major problem – however, if the bulge increases and/ or the symptoms increase, will the only surgey possible be a ‘disectomy and fusion’ or would a microdisectomy suffice? The reason I ask is I have never read any micro-disectomy and/or disectomy study about central disc herniations – most data available online seems to only cover lateral or paracentral and lateral herniations and seem to exclude patients with central disc herniations. Is this because disectomies for central herniations have no or low success?

    Also, if micro-disectomies have a low success, what is the success rate (in terms of return to a close to normal life) for disectomy & fusion surgeries for central disc herniations?

    Thanking you in advance for your response.

    Regards,
    Vidhata

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