Spondylolisthesis Grade I/II spinal fusion revision surgery

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  • Maria_2017
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    Post count: 5
    #24338 |

    Dear Dr Corenman,

    Thank you so much for the possibility of contacting such a skilled spine surgeon.
    I have a history of persistent back pain, finding were L5-S1 spondylolisthesis grade I/II with disc degeneration and foraminal stenosis. I had a spinal fusion at this level (4 screws and 2 bars), bilateral laminectomy and a slight reduction of the spondy but not very much. The orthopedist doctor could not insert a cage between the vertebrae ( I think space was too narrow, not sure).

    Now 5 years after spinal fusion I still suffer from incapacitating pain, null with lying down (when not inflamed) and pretty severe after starting doing daily life. Saw a couple of neurosurgeons and 2 of them say I might be suffering from pseudoarthrosis, since there is no fusion between the vertebrae. But my surgeon and others argue that the screws are holding it since I my flexion and extension X-rays don’t show movement, unless it is micro movement, they said.

    I have central back pain at the surgical site and bilateral leg symptoms that come and go. I am helped by an osteopath to keep this at bay. Also my muscles are weak around this are because I have pain and don’t move as much.

    I would be very happy if you could give me some advice to recover my life back. I am only 35 yrs and want to move forward with my life.

    Thank you so very much,

    Maria

    Dr. CorenmanDr. Corenman
    Moderator
    Post count: 5036

    With no cage placed in the disc space, it is unlikely that you have a solid fusion. I would disagree that “the screws are holding it” as these are temporary devices that depend upon the fusion to occur to prevent motion in the long run. You might have a posteolateral fusion (between the transverse processes and the ala of the sacrum) but I would also doubt that. I would think you would benefit from a new CT scan (1mm fine cut) to determine your fusion status and if you do not have a solid fusion, a revision would be appropriate. The CT scan only needs to be performed at the L5-S1 level and not at any other levels to prevent further x-ray exposure.

    By the way, you can always get a cage into a disc space in a segment that has not fused. It is essential with an isthmic spondylolisthesis as you need to create space between the vertebra to reconstruct the foraminal height.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Maria_2017
    Participant
    Post count: 5

    Dear Dr Corenman,

    Thank you so much for your quick reply. I would actually would see you if I was not on in Europe.

    When I woke up from my only spinal fusion when they get me to stand up and walk, I had a huge pain in all my left leg that I never had before. From the imaging exams no screw is touching the nerve root, but it is close by. This pain got better over time but sometimes comes back. My question is if I have possible nerve damage?

    Also some months ago I did a rhyzotomy on the left leg L5-L4-L3 and L5 transforaminal epidural, did find relief from leg pain but not back pain.

    Now I am back to having intense pain with activity and sometimes a shooting pain to my ventral left side (this started a few month ago before rhyzotomy).
    Also I forgot to mention that sometimes I have cracking sounds from my spine and some are followed by pain. Is this an indication of vertebral movement and instability?

    Is it possible to place a cage even if the space is quite narrow, I believe the doctor tried but could not.

    Thank you so very much for your help and care. I am trying to find a solution for this debilitating and depressing situation.

    Dr. CorenmanDr. Corenman
    Moderator
    Post count: 5036

    I would assume the new pain in your left leg was from the collapse of the L5 vertebra on the sacrum after the attempted fusion and compression of the left L5 nerve occurred. If you do not place a cage into the disc space to distract the two structures apart, the foramen will narrow further and cause nerve compression.

    If you have periods of no to minimal pain in your leg, it is unlikely that you have permanent nerve damage. I assume you have an unstable level that intermittently compresses this nerve root.

    It is always probable that a cage can be placed as long as the level is not fused. It takes some time and technique to work the two levels apart but that demonstrates the capability of the surgeon. Find one that has 20 years experience and is meticulous. I have no doubts that a good surgeon in Europe is close by.

    Popping and cracking can indicate a non-fused level but can indicate other disorders as well.

    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.
    If this forum has helped you, please let Dr. Corenman know!

    Maria_2017
    Participant
    Post count: 5

    Dear Dr Corenman,

    Thank you so very much for your answers and for caring for patients who are not yours!
    It took me a while to digest your information. And meanwhile I have seen my doctor (orthopedic surgeon) that is very interested in following me but wants to avoid surgery. He told me my vertebra L5-S1 were almost bone on bone so no cage and as you said only posterior fusion (that is if it has taken). I am also seeing a good neurosurgeon and I know he wanted to re-do my fusion and place a cage in between.

    My question is if I have some sort of chronic neuropathy? When resting and when I wake up I am fine then when I stand up and start moving is the real problem. Is lumbar burning pain from inflammation or nerves.

    I will be having an MRI soon.

    My doctor worries that a second surgery might not be of benefit.

    Thank you for your dedication.

    Maria

    Dr. CorenmanDr. Corenman
    Moderator
    Post count: 5036

    Probably, the lack of symptoms from rest are an indication of no significant chronic radiculopathy. The roots become painful when you load the spine and compress the roots. A CT scan (fine cut-1mm slices) will be helpful to understand if there is a fusion and the MRI will note the compression of the L5 roots.

    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.
    If this forum has helped you, please let Dr. Corenman know!

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