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  • Kathy.P
    Member
    Post count: 3

    Hi Doctor Corenman,

    I have recently been diagnosed with spondylolisthesis 05-L1 approx 50% after CT scan and X-rays . I have constant lower back pain and also pain in my left leg from top to bottom which seems to move around and intensify as the day goes on . The CT scan also showed two disc hernias according to my orthopeadiatrician. He says this is something i have had for a long time and has gradually got to this stage after giving birth 21 months ago , heavy lifting and years of gymnastics in my younger years . I am now 34 years old of British origin but now live in Greece. My doctor has put me on an NSAID but with not much releif so far . I am to return to him in 2 weeks for another consultation .
    As i have to pay for all medical treatment here i need to make sure i am making the right decisions as resources are limited here in Corfu and i am considering going back to UK for further advice , i thought i might just ask a top professional like yourself if i am being guided in the right line and for some of your professional advice.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    Your descriptions indicate you have an isthmic spondylolisthesis of L5-S1 grade II-III. Please see the description of this disorder on the website. This disorder has been present mostly likely since you were a young teenager and has advanced in the amount of slip. The leg pain is from the foraminal stenosis associated with the isthmic spondylolisthesis (also described on the website).

    The conservative treatments necessary to give your relief are physical therapy and selective nerve root blocks (again- see website). PT has to be done in the “stenosis position” (pelvis posterior rotation). At your advanced slip level (grade II-III) however, I am not convinced that conservative measures will be successful. You most likely will need surgery in the future so a trip back to England might be beneficial.

    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.
    Kathy.P
    Member
    Post count: 3

    Hi Dr Corenman,

    Many thanks for your swift reply and may i just say what an amazing website you have . I am using it frequently to learn as much as possible regarding my newly found diagnosis.
    So far NSAID that i have been perscribed has not offered any releif and i have constant pain from the bottom of my back , right across to my left hip,right down my left leg, from left buttock down to back of left knee and constant varying pain in front of lower left leg which often feels numb and incredibly heavy when walking. Sitting or leaning forward may offer a little releif but not alot. I have also felt the last few days an occasional pain under left arm and a light numbness , does this have anything to do with my condition ? I am eagerly waiting for my next consultation with my orthopedic (in a week and a half) as pain has me close to tears!

    Many thanks once again

    Kathy

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    First- the arm pain and numbness is not related to your spondylolisthesis.

    The “heaviness” of your leg is a bothersome symptom to me. Heaviness can mean motor weakness which is a problem that needs to be addressed sooner than later. The L5 nerve is the one that is compressed in your situation and if it is not generating signals to contract the muscles that your brain is demanding, this can cause permanent damage to the nerve.

    The four major muscles that the L5 nerve serves are the tibialis anterior, the extensor hallicus longus (EHL) and the gluteus medius (and occasionally maximus). There are also the peroneal muscles.

    To test the tibialis anterior, simply walk on your heels keeping your foot in the air (off the ground) with each step. If you note the foot does not want to stay up, further test by standing next to a counter and balancing your weight on the counter with your hands. Lift one leg up off the ground and perform ten repetitive foot raises with the other leg. Match your “good” leg to your symptomatic leg. Are they the same or is there a significant performance difference? If the symptomatic leg is much weaker, you have foot drop and a neurological motor deficit in your painful leg.

    To test the gluteus medius, you need to be undressed in front of a mirror. Lift your painful leg up and watch the level of the pelvis on that side. It should RISE UP. This means the gluteus medius muscle is working on the OPPOSITE side. Then bear weight on your painful side and lift the “good” leg. The pelvis should rise up on the lifted leg side. If it drops instead of lifts- you have a positive Trendelenberg sign and a weak gluteus medius.

    The extensor hallicus longus (EHL) is a small muscle on the top of your foot. It truly is important only if you are a karate expert, a soccer player, a football place kicker or a rock climber. It is the “canary in the coal mine” for the L5 nerve root. It is easy to test as it can be overcome even when neurologically intact by a skilled examiner. Simply lift your great toe with your leg crossed in your lap (if you can do that maneuver) and try to push the big toe down with your fingers. You can easily test the strength by comparing the opposite sides.

    The peroneal muscles keep the ankle from twisting. Generally, when walking, especially on uneven ground, the ankle wants to twist in. The muscles that prevent this action are the peroneals on the outside of the leg. If you feel like you are always on the verge of spraining your ankle, these muscles may be weak. Testing them during a physical examination requires a skilled examiner.

    Generally, if you have EHL weakness, it is not too important but if you have tibialis anterior, peroneal or gluteus medius weakness, it is my opinion that surgery is warranted.

    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.
    Kathy.P
    Member
    Post count: 3

    Hi Doctor Corenman,

    Just tought i’d check in with you. Since the last email i couldn’t wait for my next appointment with my Orthopedic due to constant pain and took myself back for a review . He stopped the oral NSAID and gave me daily injectable NSAID which seemed to offer some releif and then on doctors advice was told to inject every other day ,take paracetamol inbetween and then eventually every two days etc etc . I have so far got to injecting every other day(for just over two weeks now ) but am now back to square one if not worse as the back pain ( slightly to my left of the lower spine) is getting unbearble, sometimes feeling like repeating stabs with a sharp object.Leg pain is still same too .
    I have now booked a trip back to the UK at the end of March to take things further so i am now gathering all info possible . As i still have quite some time to bear i thought i might keep a pain diary if you would be so kind to advise how this is done . I have read of these on the forum and would like to know how the pain scale works and if you think this would be of use as i now await to see spinal specialist in England .

    Kathy

    Donald Corenman, MD, DC
    Moderator
    Post count: 8408

    Keeping a pain diary is really designed for tracking results of a nerve or facet block. None the less, understanding what activities create and relieve pain should be helpful to your surgeon to understand the biomechanics of your disorder. Take mental note of what activities seems to create the most pain and what you do to relieve pain.

    Injection of NSAIDs is not recommended on a long term basis. Try to get something else to relieve pain.

    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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