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You have what is described as an isthmic spondylolisthesis- grade II at L5-S1 with a concomitant mild degenerative disc at L4-5. Please read the extensive information regarding this on the website.

The slip amount at L5-S1 is larger than “normal” (Grade I) and this is why it probably creates more pain. Pain can be back pain and instability or leg pain or both. The leg pain would initially be caused by standing and walking and relieved by bending forward and sitting. After further degenerative changes, this leg pain could wake you up at night.

If you could respond to therapy and epidural injections, that would be the next step as long as you have not developed motor weakness.

The repair is the “blue plate special” (if you are old enough to remember that), a very common surgical repair. The surgery is called a TLIF with a Gill procedure and can eliminate pain and restore function. You can find a description of that surgery on the website.

Dr. Corenman

It looks like you have obtained good care up to this point. I will assume that the second surgery to gain a fusion at C5-6 was successful. Please tell me if that has not been assessed fully yet.

I will also assume that your pain is mainly neck pain and headaches without significant shoulder or arm pain.

Pain can be generated from the facets or the discs. Have your upper facets been included in the diagnostic facet injections? These facets commonly can cause headaches.

Have you had standard X-rays including flexion/extension? These can yield a treasure trove of significant information.

Dr. Corenman

I would love this to be fully true but unfortunately, it is partially true. The effects of gravity do create a toll on the human frame. The main problem is the thoracic kyphosis (the forward curve of the middle back or chest) advances with age. This does create greater strain on the neck and lower back. Extension exercises which most of us do not do would be helpful.

The problem with this theory is that spines deteriorate with exercise too. SInce the discs are essentially avascular, injuries to the discs are permanent. The effects of occupation, daily living, trauma and genetics produce wear in the spine. Many patients who come into the office suffer from antalgia- the abnormal posturing of the body to prevent pain.

If you had lumbar stenosis (see website), you would bend forward at the waist to prevent your lumbar nerves from being crushed. If you had significant symptomatic lumbar degenerative disc disease, you would bend backwards at the waist to unload the painful discs.

I agree that individuals need exercise to stay healthy and posture is one of the more important items to focus on but it is not the only one that needs to be addressed.

Dr. Corenman

You have a number of problems going on at once. Let’s break them down to simpler elements to allow some basic understanding.

The HLA B-27 is a genetic marker that makes you more susceptible to autoimmune phenomenon that can affect the musculoskeletal system. That is, you might have your own immune system attack your spine causing pain, stiffness and aching. Have you been diagnosed with a disorder called Ankylosing Spondylitis?

The pain in your neck and right shoulder/arm/hand more likely than not is not related to an autoimmune phenomenon. You have a disc herniation at C6-7 that is compressing the right C7 nerve root. This can cause neck pain that radiates into the shoulder, arm and hand, especially into the middle fingers. Sound familiar?

You have what I like to refer to as CNS or “crappy neck syndrome”. You have four consecutive discs in your neck that are degenerative. The upper three discs bulge and efface the thecal sac, the sack of water (CSF) that surrounds the spinal cord. By your description, other than at C6-7, these bulges do not compress the spinal cord. These upper discs can cause local neck pain but should not cause arm pain if they do not press on the nerve roots.

What is the percentage of neck pain vs. shoulder and arm pain? This makes a big difference in prognosis. If you have mainly neck pain (let’s say 70%) and only 30% shoulder and arm pain, surgery for the C6-7 level will probably only give you 40-50% total relief as the neck pain is most likely caused by all the problem discs. Fixing one disc will only relieve about 20% of your neck pain (about 1/4th of 70%) and should eliminate most of your arm pain (the remaining 30% due to arm pain for a total sum of about 50%)

If we turn the numbers around and assume you have 30% neck pain and 70% arm pain, then you can speculate that you should have a total of 80% relief of pain (1/4 of 30% is about 10% and then add elimination of the 70% of arm pain for a total of 80%).

There are some bold assumptions made with that prognosis but that is the general thought process for relief of pain by surgery.

Grinding and popping in the neck is normally related to the facets. Normally, noises made by the neck are not painful but if you do have pain, degenerative facets could cause this. Do you have a degenerative spondylolisthesis on your flexion/extension X-rays (see website for explanation)? If the facets do generate pain, these can be diagnosed by facet blocks and possibly pain reduction could come from rhizotomies (see website).

Visual disturbances, ringing in the ears and trigeminal neuralgia are all mediated by intracranial processes and are not my specialty. You would have to consult a neurologist for information on those processes.

An elevated white count could originate from many different processes. If you have an elevation from your autoimmune process, this elevation should be able to be ruled out as an infection by the appropriate specialist (rheumatologist or hematologist). This should hopefully clear the way for surgery (most likely an ACDF) at C6-7.

Dr. Corenman