Leesa,
My thanks again for asking after me and how my visit went on Friday. I'm posting a somewhat lengthy reply which follows.
My appointment with the orthopedist Friday AM was much different from any of my previous appointments with orthopedists since this doctor specializes in spine surgery. First off, he was friendly and not condescending, and after he introduced himself to my wife and me he asked me to describe my situation. I gave him a detailed sheet that I had prepared which he read, asked me some further details and then told me that he did not believe that I had progressed to a Grade II anterolisthesis.
He said that he didn’t pay a lot of attention to others interpretation of MRI results via reports and that he preferred to view the films/CD and then draw his own conclusions. Based on the CD from my 4/29 MRI he interpreted my situation as Grade I. For comparison I had the films from my prior MRI’s 8 and 9 years earlier and he sat with us and showed us how he would interpret those results. He explained the sagittal and transverse views to us and then drew lightly on the film to show us the actual slippage at that time. He measured the slippage of L5 vertebrae on S1 it was < 25% at that time and the latest MRI was essentially the same in his opinion.
He explained the significance of the neural foramen and showed us on my old MRI film the difference between nerves exiting the left (relatively normal) vs. the right (moderate narrowing). He said that the latest MRI shows some additional narrowing on the right which certainly could give rise to my pain.
He ordered AP and lateral plain films which he had printed out and then brought them to us. He showed us that there was no significant movement in my L5/S1 joint between the 2 views which meant that my anterolisthesis was stable. Further, he outlined on the x-ray the antherolisthesis and again the slippage was <25%.
The plan then is for an extended course of PT with a woman who specializes in PT of the spine. I dealt with her 8-9 years ago and she helped me a great deal at that time. He wants her to focus too on my hamstrings which he described as tight as piano wire and which only aggravate my situation. Too, he said that some belly weight loss on my part could reduce the constant distortion on my spine but he acknowledged that this is always easier said than done even with this type of motivation. This won’t correct the damage done but could only improve my situation.
If I still need some relief in the future we will consider injections but neither he nor I are pushing for them. We left it that there was no need for a formal follow-up appointment unless I was not improving or there was a significant change for the worse in which case I should follow-up for an appointment. He allowed that there was no need to consider surgery at this time so it was never discussed at this visit. He also said that he would pursue a slow and very conservative treatment plan to postpone surgery permanently or for as long as absolutely possible.
All in all, this was better than I was expecting from all aspects. I’ll post back after I’ve had my PT evaluation and some time to apply the exercise program.
Dave
Quote:
Originally Posted by Leesa
Hi ~ Well, since you are diabetic, I would THINK that any type of surgery would best be avoided!! Spinal surgery should be avoided for ANYONE, but particularly for you!
You have degenerative disc disease throughout the spine, but we ALL have that. It's just a part of aging, unfortunately. It's drying out of the discs, which makes them flatten and when they flatten they tend to bulge & sometimes herniate.
Then you have foraminal narrowiing -- the foramen are the holes that the nerves pass thru to get to the spinal cord, and yours are getting narrow.
Then there's mild spinal canal stenosis - narrowing of the spinal canal -- thank goodness it's mild. 
But then you have SEVERE facet joint arthrosis -- which just means a degenerative disease of a joint. Doesn't tell you much, does it. 
I would certainly want to take as CONSERVATIVE a route as I possibly could and try ALL conservative methods until they were exhausted. I would not jump into surgery until I had tried everything. Surgery will NOT relieve your pain. Surgery is only for mechanical problems, and not for pain. Usually, after surgery, you're left with the same pain or worse. 
Then you have to worry about the "Domino Effect" which most doctors don't tell their patients about. It's when the levels above/below the surgery site fail, because they've had to take on more of the load. I had both my surgeries before the internet, so I couldn't research properly -- and lo and behold, both levels above the surgery sites failed, meaning more surgery. Then after THAT surgery, the level above THAT one failed, meaning more surgery. And on and on......... That's where I stopped. I'm now disabled. 
So try to stay conservative. I know you're suffering. If you haven't already, try a pain management doctor too. I wish you the very best. Please let us know how you come out, will you? We'd really like to know. God bless and please take care. Hugs, Lee  |