Archives

Your initial surgery results for what I assume was a degenerative spondylolisthesis was good as should be expected most of the time. Now, some years later you have developed painful buttocks symptoms radiating down to the feet. You also note motor weakness. You state that the MRI and CT scans don’t demonstrate what is causing your symptoms.

Some questions. Are your pain symptoms equal in both legs or is one leg much worse than the other? Where is your weakness? Did a formal physical examination demonstrate any specific muscle weakness? For example, was there weakness of your quadriceps muscles (front of the thigh muscles) that made your stair climbing ability poor? Is your pain worse with standing and walking or with sitting? Have your bowel and bladder habits changed? Is your balance worse? Do you have problems with your hand coordination now?

What did your studies reveal? Did you have standing X-rays including flexion and extension views?

There are many unanswered questions that when answered can possibly point to the correct diagnosis.

Dr. Corenman

Aquatic therapy requires a stable spine unless you just use a kick board in the pool. With this slip, you develop significant spasms in the pool. This is the muscle reaction to the instability. You might be better off with a more stable exercise like the use of a stationary bike.

Stable vs unstable slips have to do with both the amount of slip and the reaction to the instability. In general, 3mm of motion from flexion to extension is worrisome. I have a patient in my office now with 5mm of slip and no significant symptoms. She will be watched very carefully but I assume she will eventually need surgery.

Your total motion of 12mm is significant. I think a surgical option is on the table now.

Dr. Corenman

The information written down could be either one if a mistake in nomenclature was made. If the spondylolysis was present prior to the first fusion surgery, how was the decision made to fuse L5-S1 made? If the comment “hypermobility” was made, this typically is noted with X-rays of the patient bending forward and backwards (flexion-extension X-rays).

Dr. Corenman

I am concerned about the report of spondylolysis at L4-5. Do you mean spondylosis? This is confusing but spondylolysis is a fracture of the back of the vertebra (see website for description) and spondylosis is simply degenerative disease.

If you do have spondylolysis, was it present prior to the L5-S1 fusion or is it new? You note hypermobility. Was this proven on flexion-extension x-rays?

If you do have spondylolisthesis with instability (see website), you may need a fusion of that level or possibly a pars repair if the disc is still intact (again- see website for pars repair). You did note previously that the disc at L4-5 was degenerative and that would preclude the repair of the pars.

Dr. Corenman

You had a hyperflexion injury to your neck three years ago and you feel your neck is unstable. I assume you have had X-rays including flexion-extension X-rays. I also assume that you have had an MRI on a quality machine.

Sharp pains with certain positions and a general ache in your neck could indicate instability. Typically with hyperflexion, the facet capsules can be torn and an injury to the back wall of the disc can also occur. The flexion-extension X-rays are invaluable as you can track the global motion of the vertebra and infer injury based upon motion analysis.

There is a condition called a degenerative spondylolisthesis that can occur (although in your case it would be called a traumatic spondylolisthesis) that is revealed by the X-rays. The MRI would be able to note back wall tears of the annulus of the disc.

You first need a diagnosis. You need to find a “sports” spine surgeon who has some experience and knowledge of this disorder (there are some who do not understand this disorder). There may be treatments short of surgery that can stabilize the neck. I would not recommend further manipulation until this matter is addressed.

You might carefully try the “neck sit-ups” exercise video found on the website to see if that can give some stabilization to your condition

Dr. Corenman