Deepcove22MemberOctober 20, 2012 at 9:36 amPost count: 14
I had a fusion at L5-S1 over 20 years ago for spondylolisthesis. The surgeon used bone chips from my hip and casted me for 3 months. After intense physio, I spent 20 pain free years enjoying sports, rock climbing, biking, nursing career.
Now, I am having severe lower leg pain, numbness, weakness and back pain. Traction and squatting help. My back is very warm to touch and I use ice frequently. Exercise worsens symptoms.
On flexion-extension xray I have a 12mm movement. A CT scan is this week.
My questions are: what grade is 12mm, what is the likelihood of avoiding surgery and what is the success rate of re-fusion?Thank you very much.
Leslie from Vancouver, BCDonald Corenman, MD, DCModeratorOctober 21, 2012 at 12:42 amPost count: 8460
I assume that you did not have screws and rods when the fusion was performed. I also assume that you have 12mm of motion of L5 on S1 as you have developed a pseudoarthrosis (lack of solid fusion).
Your current symptoms fit with the above assumptions. The foramen that the L5 nerve roots exit from are deformed from the instability and the nerves are compressed. Your lower back pain is from the instability and certain motions will increase the slip and therefore, back pain.
If my assumptions are correct, you will ned a redo fusion surgery at L5-S1. A redo surgery is not uncommon under these circumstances and the success rate is still very high. If my assumptions are wrong; well, back to the drawing board!
Dr. CorenmanDeepcove22MemberOctober 21, 2012 at 6:07 amPost count: 14
Hello and thank you for your reply.
Yes, I had a bone chip fusion the first time and not screws.
Yes, the level is L5-S1 where the 12mm slip is.
What grade would you call a 12mm slip?
Can I ( should I) be swimming? Is this good or bad exercise right now?
Is a 12mm slip urgent or not?
Finally, is a fusion using screws better than bone chips? I had 20 years with a bone chip fusion.
Thank you again for your time!!
LeslieDonald Corenman, MD, DCModeratorOctober 21, 2012 at 9:48 amPost count: 8460
A fusion of L5-S1 with a preexisting isthmic spondylolisthesis without screws has a high rate of non-union (no fusion). The surgery itself will create further instability if the fusion does not occur. This is what has happened in your case.
A 12mm slip is typically called a grade 2 slip.
Swimming would be a good exercise for you. A stationary bike would also probably be OK.
The purpose of screws is to hold the two vertebra together to prevent motion while the vertebral bodies heal together (in this case the L5 vertebra to the sacrum). If motion is allowed while healing this many times leads to a pseudoarthrosis. This lack of healing has occurred in your case.
What you most likely will need to finally fuse these two vertebra together is a TLIF. See the website and also read about BMP, a synthetic protein that induces bone formation.
Dr. CorenmanDeepcove22MemberOctober 22, 2012 at 8:50 amPost count: 14
Thank you very much for both of your replies and your thoughtful answers. They will provide much anticipatory guidance. I will have my CT tomorrow so the answers will come soon as to the extent of slip/compression.
All the best,
Leslie from Vancouver
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