Robert1MemberDecember 24, 2011 at 4:10 amPost count: 2
Hello Dr Corenman,
I am an active 46 year old male that was weight training, and running up until about mid October. At that time I started getting sciatica symptoms on my right side with glute pain, off and on leg pain, and the occasional zap. After about 4-6 weeks of no change I went to see a chiropractor who began treating it for a disc bulge. I did start getting some relief but insisted on an MRI because it seemed my symptoms were a little different. I get the classic relief when sitting or bending over.
I just received the MRI results and was expecting a bulge confirmation and was kind of shocked to find that I have, grade 1 spondylolisthesis of L5 on S1, extensive degenerative disc disease of L5-S1, possible spondylolysis but they can’t tell without CT, border line spinal stenosis at L3-4, and degenerative changes of the facets on L5-S1.
At this point I’m really bummed because I probably will have to stop running and weights. What should I do at this point? Will any type of PT get me to a point where I can be pain free and be able to do low impact excercise or should I start thinking about surgery now?
Should I continue with the chiropractor, I seem to have gotten some relief but maybe it’s coincidental?
I’m kind of surprised that I really didn’t receive any warning signals before it got to this point. I also have a very rare autoimmune disease called Relapsing Polychondritis and have been on about 17.5mg of methotrexate/week for about 3.5 years and my symptoms have been controlled. Do you thing the RP or the medication may have contributed to my disc problems? What usually causes this, is it just a lifetime of running and weight training?
Thanks for any help and guidance.
RobertDonald Corenman, MD, DCModeratorDecember 24, 2011 at 4:42 amPost count: 8436
By the sounds of your MRI- this could either be a degenerative spondylolisthesis or an isthmic spondylolisthesis of L5-S1. Degenerative spondylolistheses are much more common at L4-5 and isthmic spondylolistheses are more common at L5-S1 but are not normally associated with degenerative facet disease. Both will cause foraminal stenosis which it sounds is one of your primary complaints (see website for details of each).
The MRI will be able to discern between the two but it may not matter for your treatment. Running will most likely aggravate the symptoms in either case so you will have to make the decision to truncate your running. You can replace running with cycling which is not specifically aggravating to the slip. Weight lifting without extension (no dead lifts and military presses) can be done safely with the proper techniques.
Chiropractic can give temporary relief and if it works for you, continue. A flat back positioning program in physical therapy will give you relief and a pilates PT works well if the therapist understands what to do.
The steroid medication most likely is not aggravating your symptoms but be careful of osteoporosis as this can be a side effect of prolonged steroid usage and can affect the disorder in the long term.
Most likely, this is an isthmic spondylolisthesis and the fracture of the pars occurred when you were young. The slow degenerative process that occurs with this condition finally became advanced enough to affect the foramen. It is very common for patients to present with this history.
Dr. CorenmanRobert1MemberDecember 24, 2011 at 4:58 amPost count: 2
Thank you for your quick reply. The thing is, the MRI also showed I have extensive degenerative disc disease at L5-S1. Would this also be present if it was a isthmic spondylolisthesis? Would the spondylolisthesis be the cause of the disc degeneration? I assumed since I had the disc degeneration this was the cause of the spondylolisthis making it a degenerative spondylolisthesis. At this point I just want to preserve what I have and hopefully get at least pain and zap free.Donald Corenman, MD, DCModeratorDecember 24, 2011 at 5:54 amPost count: 8436
The disc degeneration is associated with either isthmic or degenerative spondylolisthesis. The cause of the symptoms in isthmic spondylolisthesis is the eventual breakdown of the disc and then subsequent back pain or leg pain years after the initial pars fracture. The facets typically do not break down as the pars fracture “unloads” them.
To preserve what you have left, reduce impact activities and start with activities that put the back in more flexion (bending forward) like cycling and kayaking. You can try epidural injections as that should give some relief with flair-ups.
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