Retrolisthesis

Tagged: retrolisthesis lumbar spine

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CoachK
Participant

April 14, 2016 at 12:40 pm

Post count: 2

#21967

Having had an MRI following an extreme episode of radiculopathy, the following is a summary of the findings:
1. Grade 1 retrolisthesis of L4 on S1 associated with left paracentral disc herniation effacing the left anterior thecal sac by 7-7.5 mm. Relative stenosis of the left lateral recess; no spinal stenosis; bilateral neural foraminal stenosis. Disc space narrowing, posterior bony ridging, and Modic type II changes.
2. Annulus bulge and annulus tear at L4-L5 effacing the thecal sac 2 mm. Ligamentum flavum hypertrophy and facet degenerative change without spinal canal or neural foraminal stenosis.
3. L2-L3 broad based disc protrusion effacing the thecal sac 4.5-5 mm without spinal canal or neural foraminal stenosis.
I was out of state on vacation and experienced debilitating pain of the anterolateral thigh. The interventional radiologist at the imaging center performed an ESI at L3 to facilitate my travel back home. I am now functional with residual low grade pain and paresthesia from the L2-L3 protrusion. I seem to be asymptomatic with regards to the L4-L5 and L5-S1 status. I will be seeing a spine specialist at the Rothman Institute in Philadelphia next week. Based on this summary are there any questions you feel I should ask my spine doctor? Also, is the retrolisthesis something that can be addressed via chiropractic therapy? I am a retired surgical sales rep, and am very proficient in clinical terminology. I have reviewed my MRI in depth and fully understand the anatomic causes of my spinal pathology. I am anxious to understand the clinical implications and the course of therapy my spine doctor feels will best address these issues.

Donald Corenman, MD, DC
Moderator

April 15, 2016 at 5:41 am

Post count: 8660

#21969

First, some terminology needs to be cleared up. You note a “Grade 1 retrolisthesis of L4 on S1 associated with left paracentral disc herniation effacing the left anterior thecal sac by 7-7.5 mm”. Is that an L4-5 level, an L5-S1 level or do you have only four true lumbar vertebra and this is really an L4-S1 level (a single level at the bottom of your spine due to four true lumbar vertebra)?

If this is L4-5, then a left paracentral disc herniation should affect the L5 nerve root which radiates into the buttocks, down the back of the leg to the top of the foot. This does not mimic your pain pattern (“debilitating pain of the anterolateral thigh”). This area corresponds to the L3 or L4 nerve.

You then note an L3 nerve root involvement and even mention a problem “from the L2-L3 protrusion” but the radiological report does not mention compression from the L2-3 level (“L2-L3 broad based disc protrusion effacing the thecal sac 4.5-5 mm without spinal canal or neural foraminal stenosis”). Does this mean that there is nerve root compression or that this hernation is not affecting any nerve root?

You do have significant degenerative changes of the “L4-S1 level”. I assume this is L5-S1. The retrolysthesis (backwards positioning of the vertebra above on the one below) you note is almost always associated with degenerative disc changes and loss of disc height. The facets in the back of the spine are angled backwards. When the disc loses height, the “ramp effect” of the facets pulls the superior vertebra back on the one below. This is a natural consequence of disc height loss.

If you did not know that you had back problems prior to your leg pain episode, do not worry too much about this retrolisthesis.

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.

CoachK
Participant

April 15, 2016 at 2:58 pm

Post count: 2

#21977

Thank you for the prompt reply, Dr. Corenman. I apologize, the retrolisthesis is at the L5-S1 level. I am 64 years old and approximately 30 years ago I had significant sciatic nerve pain that progressed to muscle weakness and initial signs of ‘foot drop’. I was diagnosed via myelogram as having bulging discs at L4-L5 and L5-S1. My surgeon was considering a chymopapain injection at that time. He wanted to try an ESI first which ultimately provided near complete resolution. The ESI was repeated approximately 3 months later, and until now I have had no recurrence of any leg pain. Over the years I have had my share of lower back spasms. These have been either self limiting or have responded to chiropractic treatment, massage therapy, and/or hydrotherapy.

I assumed that given my prior history, as well as having a very physically active lifestyle, that degenerative disc disease at my age was likely. This was confirmed via a lumbar X-Ray, ordered by my primary a little less than a year ago, when I had a back spasm that wouldn’t resolve. The intervertebral space at L4-L5 was noticeably narrow, and L5-S1 was very narrow. At that time my primary explained that I had “moderate arthritis” and recommended anti-inflammatory medication. The current MRI clearly shows degeneration on T2 images at both levels. The disc height at L5-S1 is extremely narrow, more so posteriorly.

My current problem started with a ‘stabbing’ pain centrally at my belt line upon a simple forward leaning movement. I almost immediately felt tightness above my belt line (erector spinae?) and believed I had another bad spasm. However despite massage, chiropractic, and muscle relaxants over a period of 8 days, the muscle tightness and associated lower back pain would not resolve. During that 8 day period I had two additional instances of the ‘stabbing’ pain, again upon forward leaning, ie. tying my shoes while seated. On the 9th day the severe nerve pain in my leg hit me with a vengeance. I can only assume that the initial stabbing pain may have been the actual herniation and in some way triggered the spasm.

My current radiculopathy is limited to the hip, lateral thigh, and anterior thigh centrally as well as superior towards the groin. There is no involvement below the knee and the dorsal aspect of the thigh is unaffected. It is for that reason, in conjunction with the ESI at L3, that I felt this was due to some involvement of the L3 nerve. Since I have not yet seen a spine specialist, this is all conjecture on my part. My assumptions are just that, albeit based on my education and professional experience. In addition, I have thoroughly reviewed your videos as well as those of several other spinal health care providers.

Once again, thank you for your time and for sharing your extensive knowledge on spine health. I am always eager to learn and appreciate any further guidance you can provide.

Respectfully,
Warren Kay

Donald Corenman, MD, DC
Moderator

April 16, 2016 at 6:19 am

Post count: 8660

#21980

I will assume that you have some remnants of foot drop as the injections are very good at eliminating pain but do not “decompress” the nerve root and only 50% of patients recover fully from motor weakness without surgery.

Most likely you have isolated disc resorption (IDR-see https://neckandback.com/conditions/isolated-disc-resorption-lumbar-spine-idr/) at L5-S1 and possibly at L4-5. Flexing forward loads the disc and discal pain (lower back pain) is quite common with IDR.

You are correct that the current symptoms of leg pain (“My current radiculopathy is limited to the hip, lateral thigh, and anterior thigh centrally as well as superior towards the groin. There is no involvement below the knee and the dorsal aspect of the thigh is unaffected”) point to the L3 nerve root. This is verified by the injection results.

You do need to see a spine specialist. Check the section https://neckandback.com/conditions/home-testing-for-leg-weakness/ to determine if you have further motor weakness. If you do have quad weakness, make your appointment much more quickly.

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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Donald Corenman, MD, DC

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Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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