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  • kEu4FoYkiT
    Member
    Post count: 2

    I’ve had spondylolisthesis for over 20 years. Mismanaged, it progressed to spondyloptosis, with spontaneous fusion at L5/S1. The extent of the damage wasn’t discovered until about 6 years ago.

    I’ve been able to maintain an active lifestyle, competing in ice hockey and triathlon. But, I’m now suffering increasing neurological symptoms. I had a new MRI this morning, and am seeing a local neurosurgeon this week. Any way to post an MRI, or have a doctor view the images?

    My understanding is that fusion in situ would be preferred, but would not correct the postural deformity, subjecting me to lifelong degeneration. I already have bulging thoracic discs. The Gaines procedure was “state of the art”, but has fallen out of favor due to the high rate of complication? Reduction and fixation with a new type of screw (S4 system?) may now offer stabilization with reduction. Even then, how would any of these procedures deal with the spontaneous fusion?

    I’m just looking to gather as much information as I can, knowing that I have a rare condition, and I’m in for some troubles.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    A spondyloptosis for those who do not know is a full and complete slip of the spinal column off the sacrum (the “base bone” of the spine) and a descent into the pelvis. This slip creates substantial biomechanical problems for some patients as the center of gravity of the spine is shifted substantially forward and the nerves can be stretched causing dysfunction.

    You noted a “spontaneous fusion” of the L5 on the S1 segment. Are you sure of this? If these two segments fuse together, this really reduces the stress on this slip although a fusion still leaves the biomechanical problems of spinal alignment.

    Correcting the alignment of L5 on S1 is a difficult and technically demanding procedure. In-situ fusion (fusing the vertebra in place) is a less risky procedure but does not correct the alignment and still does not guarantee that a fusion will take place. If you already have a natural fusion, this makes the reduction of the vertebra more difficult.

    The Gaines procedure removes the L5 vertebra completely and places L4 on the sacrum. You can imagine the amount of nerve manipulation that would need to occur with this procedure and this can place nerve function at risk.

    Dr. Corenman

    kEu4FoYkiT
    Member
    Post count: 2

    Indeed, there is bony fusion between L5 and S1, with no cracks discernible to my untrained eyes. I used to joke with people that it’s a good thing I kept running, because all of that “pounding” created the pressure to grow bone.

    Standing, my sacrum is horizontal, and L5 is actually below S1. So, the angles are extreme, and not an ideal fused position. Plus, the latest MRI showing a strange bend with space between S1/S2. It truly is a train wreck! I fear that if I let this go, it could lead to kyphosis or worse.

    I know you will not recommend a surgeon. But, could you comment on how many surgeons in the US are qualified to operate on such a rare case? Is it 5, 500, or 5000? We are just outside the Front Rage.

    And, thank you for being such an informative resource for this community!!!

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    The problem with the autofusion in spondyloptosis is that the abnormal forces on this fusion can “bend the bone” similar to cowboys who spend prolonged time on their horses developing bowed legs from the increased pressure of the horse.

    I will operate on all slips up to a grade four (still on the sacrum-but barely) but not on a spondyloptosis. You can call the office and I will let you know who I feel is qualified to help you (888 888-5310).

    Dr. Corenman

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