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  • Adoniev
    Member
    Post count: 2

    Dear Doctor Corenman,

    I have a 6mm anterolisthesis corresponding to a grade 1 moderate bilateral spondy on L5-S1. The rest of the canal is ample and there is no other fracture.

    I also have a posterior extraspinal synovial cyst associated with the posteromedial left facet joint. The listhesis results in deformity of both neural foramina. The left is ample meanwhile the right is narrowed but there is no high grade L5 nerve compression. There is some narrowing of the right foramen.

    These are words from my MRI report.

    With this assessment I do feel pretty bad in my day-to-day: I always have pain in my lower back, tingling sensations and burning sensations escalate down my legs. I lost at least 30% of the feeling in my legs. My energy level is affected greatly and my concentration as well.

    I saw some doctors one recommended a fusion, the other two recommended to wait another 10 years before considering an operation. I took some injections one time and I felt tremendous relief but only for about 3 weeks. I heard the more you do them the longer the effect but they do have adverse effects if taken too often so I limited to taking them twice a year.

    I am considering surgery or anything that can get me my life back to 100%. What would you recommend from seeing this ? Are minimally invasive options available ?

    I truly appreciate your precious time doctor Corenman and I wish you a happy new year 2015.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    You do not note what type of spondylolisthesis you have (isthmic vs. degenerative-see website) and normally the L5-S1 level is an isthmic slip. However, ganglion cysts are associated with a degenerative slip so I will assume this is a degenerative spondylolisthesis.

    If you have leg pain and lower back pain along with losing “30% of the feeling in my legs”, I would assume you would be a good surgical candidate. See the section “when to have lower back surgery” to understand this concept.

    “Minimally invasive” spine surgery is a misnomer and a marketing ploy. 50% of the spine surgeries I do are revision surgeries (surgery to repair a pervious failed spine surgery) and most of these are repair of “minimally invasive” surgeries.

    Find a well experienced spine surgeon who is meticulous and you should be happy. You can read the section “Questions to ask your spine surgeon”.

    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.
    Adoniev
    Member
    Post count: 2

    Thank you very much doctor for such a prompt reply I wasn’t expecting this at all.

    My MRI doesn’t say if it’s an isthmic spondy or degenerative but I did start having pain in my back because I was a boxer before and took an illegal blow to the lower back. Consequently, I had to quit boxing and start a different lifestyle. I am leaning towards saying that I have an isthmic spondy because I was diagnosed at 25, I am now 28, and I had pain in my back from time to time when I was younger. How do you view the difference between both in terms of the retaliatory actions needed to be taken ?

    Do you think a foraminatomy could be effective in my case or would you say fusion is the only way to go ? When does one get one over the other ?

    Could you elaborate a bit on these synovial cysts ? How are they created ? Why ? How can they be removed and what are the effects of removing them ?

    Thank you doctor,

    Donald Corenman, MD, DC
    Moderator
    Post count: 8409

    A synovial cyst typically occurs from a degenerative facet. The synovium is the lining of the joint that produces synovial fluid, the fluid that bathes the joint. When the joint becomes degenerative, the capsule (the tough outer bag that holds the joint together) can tear and the lining of the joint, the synovium, can pouch out.

    This synovium does what it is suppose to do, produce fluid. Since there is no structure(the capsule) to control the amount of fluid produced, this pouch goes about its business producing fluid. This creates a cyst and this cyst can compress the nerve.

    With a slip present, a foraminotomy is typically ineffective to decompress the nerve. A fusion is normally required to decompress the nerve and stabilize the level.

    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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