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-   -   spondylolisthesis of the L5 (https://www.neurotalk.org/spinal-disorders-and-back-pain/152832-spondylolisthesis-l5.html)

Dubious 12-04-2011 11:08 PM

Quote:

yes i also had spinal stenosis and bulging disc. Alot of pressure was on my nerves.

I guess I'm confused. A spondylolisthesis is decompressive for the central canal as it actually creates more space that would significantly lessen potential effects of spinal stenosis and bulging disc. Due to the regional anatomy (Hoffman's ligaments, up/down phenomena of the IVF's, etc) the exiting nerve roots are actually at higher risk of involvment in a spondy so I guess I am confused that as to whether or not you surgically had a pedicle screw reduction of a pars defect (for the spondy) or simply a discectomy/fusion for the disc and stenosis?

kate rae 12-05-2011 09:44 PM

Make sure you get a second and even a third opinion. If the nerve is being impinged on it will cause more damage. It needs to be free. If the doctors opinions are the same and your in alot of pain I would try to get surgery and get it stable. I say this because I've had 4 l5 s1 discectomies and another for lg chunks of disc imbeded in the nerve encassed in scare tissue. The last surgery I had there was no more disc left so I had a l5 s1 disc replacment. this made a world of difference. The nerves were being crushed and pain like that no medication could touch those levels, so this is why I say the nerve needs to be free whether it's bone fragments, disc material,spurs, alignment issues it needs to be off those nerves. I went to HSS in NYC great hospital very knowledgable surgeons and the staff is professional. They also have a great financial program. Just double check everything and bring a list of questions. I also took my father there due to a local hospital major mess up and the did a limb salvage surgery on him he is great like a miracle. Good luck and hang in there.

flahair2 04-11-2012 02:22 AM

Quote:

Originally Posted by Dubious (Post 785135)
Hi Steve,

The pathogenises of a spondy is repleat in the literature so I won't bore you with it. Yes, you have most assuredly had this your whole life short of a (very) traumatic injury.

Conservative treatment is strongly recommended and for good reason. The surgery is huge and wickedly brutal with about a 1 year recovery and frankly, the patients that I polled felt no better or worse after the surgery, thought it was a failed waste and wouldn't do it again. Activity modification and avoiding known precipitating events are essential with a mix of various pain management procedures like interlaminer epidurals, selective nerve root blocks, facet blocks, medial-branch blocks and pelvic traction/exercises in PT. You can try accupuncture or chiropractic as everyone has different success stories and may have something to offer. There is no good answer but I think you have some things to work with. You can also get a special lumbar elastic support that has a sleeve for which a plastic thermaform plate is contoured to your body and inserted into the sleeve. That gives some a lot of relief.

As a surgeon told me, you only do a fusion on a spondy when the patient is in prolonged intractable pain, crawling on thier hands and knees for awhile, all conservative efforts have failed and they are ready to shoot someone!

Good luck!



Not sure where to start a post so Being that your statement is very thorough, I thought I would post under yours. I have a good friend that has just turned 80! she has kyphosis bent over but not at upper back.. she is bent from well, like in the pike position, but not so much a 90* as more 130*. She was hit by a pick up while crossing the road some @20 yrs ago. She got up and walked away and took herself to the local ER, they said since she walked in on her own she was fine and sent her home!!! BAD MEDICINE THAT! oh well. anyhow shes dealt for years using water arobics to keep moving. SUDDENLY shes got severe sciatic pain down her right side, having incontinence issues and is at the point she is in tears in the AM and barely makes it out of bed. I saw a 7 yr old MRI and her L4 is slipped over L5.( i cant imagine what it is now) She was one that said NEVER to back surgery but now is so desperate for pain relief shes even got her bags packed at her door!! I have taken her to ONE neurosurgeon and hes sent her for Standing MRI only because she cant get up once she lays down for it. He did take an Xray in the office. She is 5'5" , aprox. 220lbs. has some kidney issues but not on dialysis. Doc , was not interested in surgery , offered steroid but shes scared of them due to side effects of swelling. I told her what is a bit of swelling over the pain ? so shes now telling me 2 wks later shes more than ready for the Steroid as shes in such pain. We already have a second doctor appt with another to get a second opinion and have seen online a Bonati spinal place that will give you a review of MRI as well. She had been moving around and all fine, so mechanically she wasnt having issues, im assuming <cough cough> that the vertebrae arepressing on nerves now. I read that this wont help pain? just mechanical function? So would this be a useless avenue to persue? I wish she wouldnt do anything due to her age but shes in so much pain shes telling me if a doctor gave her a 50/50 chance shed take it. shes done no blocks/ no stimulators/shes told me when i mentioned block that "oh no they could paralzye you". UH? surgery????? wondering what other options are there?

ginnie 04-11-2012 08:47 AM

Back issues
 
Just a thought about surgery. if L4- is slipped over L-5, that may constitute a need for surgery. I never think surgery is good, unless the pain has become so severe, that quality of life is compromised. I had the same thing happen, C5- was slipped over C-6. The ones above that reversed the curve. I did have surgery, and it did turn out OK. My pain specialist said there comes a come when shots, blocks and intervention conservatively doesn't work anymore, and that is the time to investigate a surgical approach. An elder friend of mine had back surgery, and she was in her 80's also. Her surgery did OK for her and greatly reduced her pain. I hope everything turns out OK. ginnie

flahair2 04-13-2012 04:08 AM

Quote:

Originally Posted by ginnie (Post 868716)
Just a thought about surgery. if L4- is slipped over L-5, that may constitute a need for surgery. I never think surgery is good, unless the pain has become so severe, that quality of life is compromised. I had the same thing happen, C5- was slipped over C-6. The ones above that reversed the curve. I did have surgery, and it did turn out OK. My pain specialist said there comes a come when shots, blocks and intervention conservatively doesn't work anymore, and that is the time to investigate a surgical approach. An elder friend of mine had back surgery, and she was in her 80's also. Her surgery did OK for her and greatly reduced her pain. I hope everything turns out OK. ginnie

Thanks Ginnie, She has since changed her mind. She is taking the oral prednisone dose pack, although shes terrified with her kidneys being stage 2 impairment. Im thinking which outweighs which ? pain or risk of damage? She is awaiting a call to go in for a epidural in hopes of calming the nerve down. I really think shes looking at surgery. The doc is saying that since she lived with the slip for so long, that the ruptured disk is creating the problem. I hope she can get some decent time with reduced pain from the epidural. The pain is getting worse rapidly as she went from NO EPIDURAL to waiting by the phone for the call to do one!

ginnie 04-13-2012 10:11 AM

Hi flahair
 
Hello, and I am sorry about that painful condition. I hope she is going to an actual pain specialist for the epidural. These injections sometimes really help, and at other times they do not. Each person is different. In my case I didn't get the relief and went for Katemine infusions. these did work for me for a period of about three weeks each of them. In my case however, the pain specialist was the person who told me, they just could not control my pain and he sent me to the best Neuro surgeon around, since old hardware and the curve of my spine had to be addressed as well. If her pain specialist ever comes to the point they cannot help. that certainly is a time to consider a surgical solution. I was on morphine on a high does, and the Katemine infusions stopped working. Also under the guide machine, he could see what was happening in my spine. I do wish her all the best. I hope you can find the solution, to lead to a better quality of life. Keep in touch, and let me know how it goes. ginnie


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