Spondylolisthesis L5/S1

Posted by jmendoza1 @jmendoza1, Feb 19, 2022

Hi All,

I have just been diagnosed with grade 2 Spondylolisthesis at L5/S1 with bilateral pars defect at L5, which has resulted in posterior uncovering of the disk and impingement of bilateral L5 existing nerves (worst on left side). I was an active runner over the last six years running a few marathons and ultra runs. However, there has been no recent incident that I can recall that would have caused this injury.

It has been quite a journey to get here, but 4 months ago I encountered right hip pain and tightness when waking up in the morning. It would take a good 10-15 mins to walk off the pain / stiffness. Pain was generally a 2 but one stage hit a 7 on a scale of 10. After physio treatment over two months the hip pain went away and hasn’t come back. However, my right calf and hamstring would feel pretty tight minor tingling on the right lower and outside of the calf and top off foot. This can be triggered by running up to 7-10km or standing and sitting for too long.

I decided to see another physio who treated the issue as piriformis strain. Things seem like they were getting better in Dec. However in January the tightness and slight numbness came back so I decide to get an X-Ray and MRI done.

Unfortunately the result came back with grade 2 Spondylolisthesis with some impingement of the nerve. One good news is that the Spondylolisthesis seems stable based in flexion / extension X-rays

The medical expert has suggested I undertake surgery which would involve a fusion (ALIF and PLIF), which was a major shock gut wrenching. I am seeing the surgeon this week to see what his recommendation is.

In the meantime, I went to get a second opinion (expert spine physio), who did not agree with the advice and suggested I try passive treatment which would involve no more running and slow build up to core training with stretches. He didn’t think the current nerve issue was serious as I was only feeling limited pain or numbness. He said to monitor this over the next 2 months to see how it progresses.

I kind of agree with the second opinion but I don’t want to risk nerve or back damage.
I am not getting any share shooting pains done my body (leg), I am walking fine, have no back pain, etc. I am just more consciously aware of the issue, which has probably affected me more mentally than anything else.

My preference would be to prevent or delay surgery for as long as possible whilst limiting any future damage to my back and nerves.

Questions:
1. Has anyone encountered something similar and what path did you take?
2. When you should implement a solution to prevent nerve damage?
3. How do you know when your nerve is getting damaged?
4. Any other advice?

Thanks in advance for the feedback.

Sorry for the long post… it has just been a bit of a mental challenge over the last few days trying to digest the news, rejig goals and plan ahead.

Cheers ,

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boisvert | @boisvert | 1 day ago

Restricting what you do and how you do the things you still can will probably be the best approach. I’ve read someone say Surgeons love to perform surgery. So true! That’s their specialty and that’s what they want to do! I’ve been told that once a nerve is damaged, there’s nothing they can do to restore it. I was told by another doctor who had surgery that the effects didn’t last long and then he was told there was nothing else they could do for him. I personally have a syrinx that effects my nerves first and foremost, DDD, stenosis and spondylolisthesis. If the syrinx gets so bad, surgery as a last resort can be “tried’ to stabilize its effects from progressing but not to reverse its effects. I’m a big believer in PT but be careful of that. I’ve found most physical therapists are not familiar with complex issues or nerve damage itself. I saw one therapist who was renounced and he didn’t even look at my MRI findings. Another who was a vestibular specialist gave me exercises to do prior to having a new MRI, which I was told it was ok to start pt first, but once the syrinx was found on an MRI, I was told to stop immediately so as not to further damage my nerves. So bottom line, be careful! Don’t ignore how your body feels even if the experts tell you it’s ok. When it comes to nerve pain, pt only takes you so far and no OTC pain meds work. I’ve found I need more than a holistic approach. Try prescription meds. Be wary of side effects but it helps once you find the right Rx. The best thing that has helped me is restricting what I do. No lie, it sucks! I can’t live the life I used to or expected to in the future but it’s the only way I can live and manage this new me. I swear, restricting what I do and modifying how I do the things I still can has made the biggest difference.