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  • smeal4128
    Participant
    Post count: 3

    Dr. Corenman:

    First off, thank you for being such a great resource to those of us suffering from some of these awful conditions.

    To provide some context, I am 25 and have had sciatic pain (more-so irritation) since about 20 or 21. As a former multi-sport athlete in HS and powerlifter, my symptoms progressed which interfered with my workouts. I was diagnosed with a herniated disc at L4/L5 in 2016 and proceeded with conservative treatment. For the next 3-4 years, I tried to train as best I could and do core strengthening, my symptoms improved but I was never able to fully return to lifting without flaring up the nerve. Keep in mind, I was never bedridden with my sciatica and very seldomly had a shooting pain (maybe 7 or 8 times total). I essentially figured I would be stuck with minor nerve irritation on/ off and would never get back to 100%.

    Whilst doing light deadlifts in March, I noticed I began developing S1 nerve root numbness in my outermost toes, the same side as the glute/ hip inflammation that I’d be dealing with for years. I scheduled an appointment with a new nuero with the following update MRI and x-ray:

    IMPRESSION:
    Increasing size to L4-5 disc herniation compared to previous. No significant spinal canal or foraminal stenosis.

    Spondylolysis and stable grade 1 anterolisthesis L5-S1. Disc bulge
    Narrative
    INDICATION:
    Low back pain, lumbar radiculopathy.

    COMPARISON:
    2016

    TECHNIQUE:
    Sagittal, axial, T1 and T2 sequences were performed without contrast. The exam was performed on 1.5 tesla closed high field MRI

    FINDINGS:
    The lumbar vertebrae show no evidence of acute fracture. The conus terminates at L1. Reporting assumes 5 lumbar vertebra.

    L1-2 disc space shows no evidence of canal or foraminal stenosis. There is no acute finding.

    L2-3 disc space shows no evidence of canal or foraminal stenosis. There is no acute finding.

    L3-4 disc space shows no evidence of canal or foraminal stenosis. There is no acute finding.

    L4-5 disc space shows disc space narrowing disc bulge and central disc herniation more prominent compared to prior study. It abuts the thecal sac but does not cause any significant canal stenosis.

    L5-S1 disc space shows no evidence of canal or foraminal stenosis. There is no acute finding. There is mild disc bulge. Grade 1 anterolisthesis is stable at L5-S1. Findings of bilateral spondylolysis are again noted.

    XRAY:

    Impression
    IMPRESSION:
    L5 spondylolysis with L5/S1 spondylolisthesis.

    1.4 mm increase in spondylolisthesis with lumbar extension.
    Narrative
    INDICATION:
    Low back pain, lumbar radiculopathy

    COMPARISON:
    MRI lumbar spine 07/13/2016

    TECHNIQUE:
    Four views lumbar spine

    FINDINGS:
    On the lateral neutral view, L5/S1 spondylolisthesis measures 4.6 mm. L5 spondylolysis. With flexion, the spondylolisthesis measures 5.2 mm and with extension 6.1 mm. The intervertebral disc heights are otherwise normal. No compression fractures.

    Also worth noting, I was making the best progress in years by fixing my deadlift form with almost a complete resolution of symptoms (I deadlifted 2 days before surgery). However, symptoms were still intermittent and I figured I wouldn’t be able to get back to 100% since there was clearly something impinging so I went ahead with surgery. Also of note, I’ve almost never had backpain and any discomfort was fixed by strengthening my core/ deadlifts.

    On September 28th, I had surgery for the doc to look at the disc and see what the best course of decompression would be. He did dual left-side foraminotomies at L4/L5 and L5/S1, noting that the disc was ‘calloused over’ and he didn’t think it should be messed with since it was clear that two bone spurs were causing my issues.

    I’ve had a somewhat slow recovery so far, but have noticed days of solid improvement. I’ve been taking ibuprofen on and off with flare ups (currently dealing with somewhat significant inflammation 9.5 weeks post-op.

    Are these flare-ups typical? Should I run an oral steroid cycle as I continue to increase my activity?

    It seems as though the spondylolisthesis was an incidental finding. If the flare ups stop happening and I return to 100%, would you recommended that it’s safe enough to return to lifting/ athletic lifestyle?

    Please let me know if you need me to clarify anything. I want to thank you in advance for any insight that you may have into my condition.

    smeal4128
    Participant
    Post count: 3

    Dr.Corenman, please let me know if there is anything you would like me to clarify. I look forward to your insight into my issue – thank you in advance.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    First, stop deadlifts. The amount of shear forces on a bad disc are not helpful and can lead to significant problems. Especially with an isthmic spondylolisthesis, deadlifts and squats are contraindicated. Your disc above the slip (L4-5) is breaking down (“Increasing size to L4-5 disc herniation compared to previous”) which is non descriptive as to nerve root compression.

    It would be unusual to have an S1 nerve root involvement in your case as the isthmic spondylolisthesis at L5-S1 would compress the L5 root typically in the foramen and the L4-5 herniation would also compress the L5 root and not typically the S1 root.

    You note; “On September 28th, I had surgery for the doc to look at the disc and see what the best course of decompression would be. He did dual left-side foraminotomies at L4/L5 and L5/S1, noting that the disc was ‘calloused over’ and he didn’t think it should be messed with since it was clear that two bone spurs were causing my issues”. Generally, in the face of an isthmic spondylolisthesis, it is problematic to do a decompression at that slip level as the minimal stability of the slip can be disrupted.

    You should probably become involved with a Pilates core strengthening program to stabilize your slip level.

    Dr. Corenman

    smeal4128
    Participant
    Post count: 3

    Thank you for your response, I appreciate it, Dr. Corenman. I will certainly refrain from deadlifts and squats to prevent any further trauma to the L4/L5 disc.

    My surgeon noted that the disc was not compressing the nerve and did not need to be removed. He did mentioned that there was a large bone spur at L5 and a smaller one at S1.

    I have never really had back pain and the surgeon believes that the slip finding is incidental since the lesion is stable. Are you interpreting that the slip is unstable?

    Should I expect my sciatica symptoms to continue to improve? As I mentioned, I was pain free for about 2 or so weeks, until I started PT and doing adduction and abduction exercises. I am again noticing irritation start to subside with no PT and just walking as therapy.

    Thank you so much.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8460

    Since this level has slipped, this means the disc is failing slowly which is the only intact structure that instills stability. The spurs he removed always develop in a slip due to the bodies attempted repair of the pars fracture that never heals. Hopefully you will continue to improve and this will be a non-issue.

    Dr. Corenman

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