Re: Spondylolisthesis

[Guest guest]

Nate <Nate7out@...> wrote:

<Well, I have a spondylolisthesis. I'd be interested to any input from those

who have experience with this. I've been to doctor; I'm not looking for

medical advice, maybe some practical advice.>

***Here is a website with some useful information on spondylolisthesis:

<http://www.orthospine.com/hottopics/spondy.htm>

<Spondylolosthesis in Adults

Spondylolisthesis describes a condition of forward slippage of one vertebrae in

the spine over another. This condition in adults is most commonly due to

degeneration (wear and tear) of the discs and ligaments in the spine. In some

patients spondylolisthesis may have developed in childhood and was without

symptoms.

This is a very different group of patients and no treatment at all may be

necessary. In the true degenerative adult spondylolisthesis one most commonly

notes a forward slippage of L4 over L5 and back pain is the most common symptom

of the condition. If severe nerve compression occurs then numbness in the legs,

tingling and weakness may also occur, particularly with activities.

Sophisticated imaging such as MRI and CT scans will show " stenosis " , or a

'pinched nerve in a narrow spinal canal'. One must realize that the imaging

studies are obtained when the patient is lying down (supine) on the imaging

table. However, most of the symptoms are aggravated by standing, walking and

other activities. The treatment for spondylolisthesis must thus aim at not

only decompressing the nerve, but more importantly at stabilizing the spine

in an optimal position.

A conservative treatment can be successful in mild conditions by using brace

and stabilization exercises. When non-surgical treatment occurs then an

operative procedure may be necessary. Various surgical approaches have been

developed to treat adult spondylolisthesis. If the spine is found to be very

unstable (excessive motion at the level of slip) then a fusion is commonly

performed. In the setting of a stable spine it is frequently sufficient to

decompress the levels of stenosis.>

-------------------

More websites on spondylolisthesis:

<http://www.spineuniverse.com/conditions/detail/ag_010300spinaldisorders_spondy.\

html>

<http://www.spineuniverse.com/flash/3.html> (Multimedia Show)

<http://www.spinesolver.com/spondylolisthesis.htm>

Some general information on the spine for anyone:

<http://www.spineuniverse.com/anatomy/heacenter.html>

Dr Mel C Siff

Denver, USA

mcsiff@...

[Guest guest]

Dear Nate,

There are many questions unanswered by your post. Do you have back pain? How

bad is the shift? What does your work / training entail? Is your training

causing you to be concerned that you may be damaging your back?

Spondylolisthesis is usually a stable condition, because the scar tissue that

forms after the injury and muscular attachements hold the slipped segmental

level quite firmly. In some cases however it can be unstable and progress and

this is of concern. Spondylolisthesis is graded from 1 - 4 , one being a small

slip, and 4 being a large. I just tried to find the exact definition of each

but it evades me at present. It is something like this though:

Gr 1 - slip of less than 1/4 of vertebral body on the one below

Gr 2 - 1/4 - 1/2

Gr 3 1/2 - 3/4

Gr 4 > 3/4 (requires surgical stabilisation).

There are many causes. Some can be congenital dysplasia, trauma, stress

fractures, fractures, tumours, degenerative, osteoporosis etc.

With respect to thing to avoid - I wouldn't manipulate one of these, and some

literature has suggested one should avoid the use of Postero-anterior pressure

as a mobilisation technique for pain relief as it may promote the instability.

Other authors believe this is not the case and it is am appropriate modality. I

myself avoid it.

Exercise is not contraindicated, and back strengthening, abdominal and glut

strenthening, hamstring and buttock stretches etc. are all advisable.

---

Epsley

PHYSIOTHERAPIST

Northside Sports Injury Centre

Brisbane, Australia.

e-mail: physio@...

On Sat, 23 Dec 2000 Nate wrote:

>Well, I have a spondylolisthesis. I'd be interested to any input from those

>who have experience with this. I've been to doctor; I'm not looking for

>medical advice, maybe some practical advice.

[Guest guest]

" Epsley " <physio@l...> wrote:

<Do you have back pain? >

Not really. sometimes some stiffness. I only get pain if i do

something dumb.

<..bad is the shift?>

grade 1/grade 2

<What does your work / training entail? >

Work is light physical lifting, sometimes a piece of furniture.

training is just the usual: squats, deads, presses, rows, snatches,

ab wheel, Janda situps, suitcase deadlifts, good mornings etc. All

the equip I have is squat rack, trap bar, bars and plates.

<Is your training causing you to be concerned that you may be damaging your

back?>

Not really. I am pretty careful.

<Spondylolisthesis is usually a stable condition,...>

I was x-rayed in Nov 1998 and again in may this year and it is

stable. I had been powerlifting all through this time period. I am

not supposed to compete any more.

Thanks, Mel and , for the replies.

Nate

chicago

[Guest guest]

Dear Nate,

As a powerlifter and 30-year spondylolisthesis (spondy) patient, I concur with

most of what and Mel said in their thoughtful responses; however, I might

add a few observations and personal experiences which I hope you might find

helpful.

First, I know of no way to distinguish or predict stable from unstable

(progressive) spondy. I first presented with Grade 1 spondy and with minor and

infrequent symptoms at age 23; by age 30, it had become Grade 4 with frequent

and severe symptoms, causing my powerlifting performance to sharply decline.

Further, the displaced vertebrae had eroded the inferior disk such that an

autofusion had occured between it and the inferior vertebrae. What made my

spondy this unstable and closely associated with disabling symptoms, when about

half of the spondy patients (~5% of the total population) are asymptomatic??

That brings me to my second point: Grade 4 spondy is NOT synonymous with

requisite surgical stabilization. In speaking with orthopedic surgeons about

this recently, they report seeing a number of spondy/autofusion patients in

their practices who never underwent surgery and who are still attempting high

levels of athletic performance. My experience at age 52 is that with due care in

performance, my symptomalogy is roughly comparable whether I'm " idle " or I'm

doing squats and deadlifts, etc.; so I choose to do them out of satisfaction.

You will find your limits on your own, and if I can pursue athletic interests,

so can you!

Third, as to etiology, my understanding is that there is essentially no

congenital basis with spondy. However, the weakness leading to fracture, usually

at the pedicle between the processes and the body, typically first becomes

apparent during development, particularly puberty for males, or following some

physical trauma. Earlier presentation than this is rare; later presentation may

reflect secondary or confounding causes, associated with pain, stiffness or

immobility. Nevertheless, there does appear to be a genetic component, but this

is hard to solidify since there is no readily accessible marker for asymptomatic

spondy.

I strongly suggest you also get good, forward-thinking orthopedic and

soft-tissue (e.g., chiropractor) practitioners on your side. Also, stay in touch

with this issue via the web, etc.

Good luck!

Dr. Jim Klostergaard

Professor

Molecular & Cellular Oncology

UT MD Cancer Center

Houston, TX

[Guest guest]

This is my first post to this list. I have only been on it for a few days.

I have had Spondylolisthesis for many years and I had a lot of trouble with

lower back and sciatic pain before losing weight and bodybuilding. Since I

have had little trouble at all. I found that the weakened state of my back

muscles greatly exacerbated the pain. I do not believe that extreme arching

for bench press is safe or effective and should be avoided completely

whether you have any back problems or not. Hyperextensions and deadlifts

have greatly improved my back strength, so I do not believe it would be a

problem. Just my opinion granted, I am not a doctor, nor do I play one on

TV.

Tim Dooley

355 Klingler Road

ding, Ohio 45879

(419) 399-4761

E-mail: caracalla@...

" Live Right, Lift Hard, and Eat Clean. "

Someone asked:

<Does any know if hyper extending the back will cause Spondylolisthesis to

get worse? How should I modify my lifting to cope with this problem? Are there

lifts I should and shouldn't do? I'm diagnosed with grade 1 for lumbar area L5.

Squats don't

seem to bother it much. Extreme arching for bench press is a bit uncomfortable.

Deadlifts feel good if I go conventional.>

[Guest guest]

Someone asked:

<Does any know if hyper extending the back will cause Spondylolisthesis to

get

worse? How should I modify my lifting to cope with this problem? Are there

lifts I should and

shouldn't do? I'm diagnosed with grade 1 for lumbar area L5. Squats don't

seem to

bother it much. Extreme arching for bench press is a bit uncomfortable.

Deadlifts feel

good if I go conventional.>

I have a grade 1 " spondy " as well. I've had some back pain history, but

there's no telling weather the pain was caused by the spondy as I also had

two disc bulges diagnosed at the same time. I've been pain free for ~5yrs

now and have had PR lifts and equaled old pre-back pain PRs.

I believe a pretty high % of the population has spondylolystheses or pars

fractures and don't even know it. My feeling is that it's not as serious as

it seems or more athletes would be ending their careers because of it.

There are probably a decent number of high-level and even elite lifters that

have it and don't know it only because they've never had an x-ray or MRI of

their spines......or I could be totally wrong about all this so feel free to

fire away.

Burkhardt

Strength and Conditioning Coach

UC Irvine

[Guest guest]

barbara, have you tried seeing an orthopedic surgeon who specializes in

spine? or a neurosurgeon? they will then take mri's etc, to determine what

your

problem is. this is not a chiropractor's job. and sometimes they can make

the matter worse. but certainly you cannot diagnose your own problem. and

not going through the proper channels can only make it worse.

getting help and getting better is a process and the first step is to see

the correct surgeon who can then diagnose you and make recommendations of

treatment. marsha

************************************** See what's free at http://www.aol.com.

[Guest guest]

Hi Marsha,

I guess my post was unclear. I have been to a few orthopedics, " a spine

specialist " , and others.

I have had had MRIs, in fact I think I just posted the last one I had.

It does state things, but I can''t seem to find a focused doctor to diagnose

anything. My last one, suggested things and then upon seeing him again would

forget, the one before said nothing I can do and gave me pills and suggested pt.

That's what I meant by diagnosing myself. If my mri report says moderate

stenosis, well, I'm saying, that's what I have, what can be done? And I don't

get answers!

I have I think 5 bulging disks, is that not DDD? At least let a doctor tell me

that, I'm getting nothing but if I insist on an injection, I've gotten them, but

they don't help.

This last guy was saying I needed hip replacement and my mri didn't indicate

any problems, so what's that say?

I've gone the proper channels, Marsha, I guess you haven't seen my other posts

and maybe I'm not clear enough. But thank you, I'm trying for almost 2 years to

get help.

Barbara

BLEECKERST10012@... wrote:

barbara, have you tried seeing an orthopedic surgeon who specializes in

spine? or a neurosurgeon? they will then take mri's etc, to determine what your

problem is. this is not a chiropractor's job. and sometimes they can make

the matter worse. but certainly you cannot diagnose your own problem. and

not going through the proper channels can only make it worse.

getting help and getting better is a process and the first step is to see

the correct surgeon who can then diagnose you and make recommendations of

treatment. marsha

************************************** See what's free at http://www.aol.com.

[Guest guest]

Janet,

At this point it's best to take a deep breath and see what the Myelogram shows. I had Listhesis at L4-L5, but my step off wasn't anterior it was to the side, along my curve, but looked odd, like that vertebrae was drastically out of line. I had stenosis and the whole shebang. My pain ran down my right hip, intense in that butt cheek, and hurt like the dickens as long as I was upright, pain subsided if I sat or layed down. Firey, stabbing pain, awful.

I had surgery, a decompression lami for it, in hopes of holding off with the big surgery till my kids got older. While the decompression got rid of the hot poker pain, it did nothing for my overall Flatback, and after a year I went onto revision with fusion to the sacrum.

So now they will have to see what your facet joints look like, how much stenosis you have, and make a plan. Surgery sucks, but if it gets rid of that nasty pain, so worth it.

So now see what the test shows for you, and make plans from there. No one like surgery, and I've had 4 of the spinal type, and hope never to have another, but for me, they got me back functioning, and got rid of the awful pain, so worth it in my mind.

Let us know how the myelogram goes and what your doc says afterward, who are you seeing and where?

Colorado Springs

[ ] Spondylolisthesis

I haven't visited in a few months. I just found out I have spondylolisthesis at the level right below where my rods in my lumbar region of my spine end. My right leg down to my foot has felt like it's on fire for 4wks. and 6 days, and my left butt cheek is numb. Has anyone else in the group experienced this and what did you do about it? Am I facing surgery? My Dr. implied that but I have to go have a Myelogram tomorrow morning to see what the nerve roots look like in there. I HATE SURGERY because I'm a nurse and I know what really goes on in hospitals. Help,Janet Bellware

[Guest guest]

Hi Janet...

It really depends on the grade, and whether or not you have pain and/or

neurologic symptoms. You'll know more once you've discussed the myelogram

results with your specialist.

Regards,

>

> I haven't visited in a few months. I just found out I have spondylolisthesis

at the level right below where my rods in my lumbar region of my spine end. My

right leg down to my foot has felt like it's on fire for 4wks. and 6 days, and

my left butt cheek is numb. Has anyone else in the group experienced this and

what did you do about it? Am I facing surgery? My Dr. implied that but I have to

go have a Myelogram tomorrow morning to see what the nerve roots look like in

there. I HATE SURGERY because I'm a nurse and I know what really goes on in

hospitals.

>

> Help,

>

> Janet Bellware

>

[Guest guest]

Janet,I also had spondylolisthesis. Pains down one leg, but mostly in the low back behind hip.I also had a real nice case of flat back, but didn't realize it until I saw second surgeon. The first surgeon was chomping at the bit to do surgery, but had no plans to fix flat back which would only have gotten worse as I aged. My first clue should have been when they had to use several medical books to get my to fit properly in the x-ray machine. My second was when the techs and nurses crowded around my x-rays, because they had never seen hardware like a Harrington rod. Make sure you are seeing someone with lots of aging back deformity work as well as experience with Harrington rods. I went through the therapy and medication route... helped for a short time, but got

worse. Some people can actually hold off longer.I needed two surgeries. First from front to place cages to pull crushed sections apart. Second surgery 3 days later, to remove part of old rod, break old fusion, put in new hardware to fuse to the sacrum. I am 6 months post-op. You can see my before and after x-rays in the Photos section.I hope you can get by without surgery. But, it can't hurt to arm yourself with knowledge about it so you can formulate questions when you see your Dr. Understand what to look for. Best wishes and keep in touch with the results.-Dyann DiamondFrom: janet7760 <janet7760@...>Subject: [ ]

Spondylolisthesis Date: Sunday, November 15, 2009, 1:29 PMI haven't visited in a few months.  I just found out I have spondylolisthesis at the level right below where my rods in my lumbar region of my spine end.  My right leg down to my foot has felt like it's on fire for 4wks. and 6 days, and my left butt cheek is numb.  Has anyone else in the group experienced this and what did you do about it? Am I facing surgery? My Dr. implied that but I have to go have a Myelogram tomorrow morning to see what the nerve roots look like in there. I HATE SURGERY because I'm a nurse and I know what really goes on in hospitals. Help,Janet Bellware------------------------------------scoliosis veterans * flatback sufferers * revision candidates

[Guest guest]

Janet,

I hope your mylogram went all right. I am so sorry you are having so much more

pain. I did have go back to your introductory post (#25233) to refresh my

memory abut who you were seeing.

As to your question about whether you are facing more surgery...my short answer

is that really is likely to depend on what you are willing to accept for

yourself....assuming there is no emergency revealed in your imaging.

With your excellent experience as an ICU nurse you must be aware that the

surgeons who do the most of a particular surgery are the ones who tend to get

the best results consistently. In your case you probably will have to travel

some distance to find a surgeon who does enough of the kind of surgery you will

require to get yourself to someone who you feel confident about. You also are

probably well aware how important the hospital setting itself is, so you should

also consider that as a variable for treatment.

I know my pre-revision symptoms match fairly closely to what you are

experiencing now, however, I had not previously had a laminectomy...and some

patients have been told that a previous lami can make treating flatback more

tricky. All that is to say, you really will want very exprienced eyes on you as

you make decisions about your future.

You live in Ohio...which is really very centrally situated as far as airplane

travel...so hopefully you will consider all the names that I am sure you have

read about here...in STL, BOS, SFO, NYC, ORD and AMR all have top notch

surgeons...so make a short list of who you might consider...cross reference for

insurance compatibility, travel accessibility and try to get yourself 2 good

opinions. I know that travel can be painful...but it might make the difference

of a very good outcome...so generally most members have found it to be worth it.

I guess to specifically answer your question...what I did about the pain and

dysfunction was research, research and more research (doctors and

hospitals...(because we all know what goes on there!)...two very good consults

for opinions, and then two days of surgery a week apart (Rand at NEBH). I am

doing very well and pain free today almost 5 years later. Naturally your milage

may vary!

Let us know how the imaging went.

Take Care, Cam