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Spondylolisthesis L5/S1
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 ,
J
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Surgery should be a last resort when the pain is so bad you can't take it anymore. I got to that point and had L4, L5, S1 fusion and multiple lumbar levels of decompression. The surgery triggered Adhesive Arachnoiditis. Be very careful. Surgeons love to perform surgery.
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1 ReactionWhat did you do about the arachnoid? I also have that foot 3 years now, and have spondylolithisis ln 3 areas, plus polyneuroppithy for 30 years. Docs arnt very helpful at all. Prayers seem to help to deal with it all.
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4 ReactionsI just was diagnosed with AA. I must have had it for a few years but the spine surgeries triggered it into rapid advance in my legs and loss of bladder/bowel control. I'm trying to find doctor that can treat it. Focused on anti inflammatory measures. Having my hormone levels checked this week.
Surgery should be your last resort. Your pattern you describe almost fits my path except mine was in 1988 and running was not a part of my regime. You are typically born with a defect causing spongylolithisis, although mine was aggravated by a fall down a flight of stairs. I should have stuck with PT more. My surgery fusion with stainless steel bars was a partial success. They now know that stainless steel causes damage to vertebrae above and below the bars, hence my ongoing chronic pain, stenosis, peripheral neuropathy. They now use titanium cages with bone that works much better, heals quicker and less long term complications. But I’m now a firm believer in PT and the longer the better. If you are a runner you’re most likely in better health than I was back then and your chances of success with PT stand a better chance of staving off surgery.
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3 ReactionsWhat led you to have L4, L5, S1 fusion? Did it happen in one go?
I have a very high pain / uncomfy threshold from ultra running so I don’t know what’s for me and willl cause future damage.
At the moment, my calf and hamstrings get really tight - feels like the next day after running 50 miles. The issue is triggers when I am just sitting down, standing up in one spot, etc. Its happening almost every day now, whilst earlier in the year : late last it it would only occur after running over 5 miles, which was bad already.
Fitness seems to be deteriorating quickly... it just seems weird. I don’t think it’s psychological after being told of the results.
Perplexed and a bit confused...
I will persist with PT over the next month and so see how that goes. Sometimes you don’t know your limits or push your limits when your to healthy...
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2 ReactionsI have degenerative disc’s disease, my discs were completely gone, bone on bone. After surgery in 2000 and 2010 I’m feeling 100%.
Now I’m dealing with Tarlov cysts in my spine from T6 to T12. Wishing you healing.
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1 ReactionI had tried all conservative treatments,including about 20 steroid injections over several years. Pain and ineffective treatments dictated laminectomies, foraminotomies, and fusion L4,L5, S1. Regretfully surgery triggered Arachnoiditis. Good luck with your issues.
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2 ReactionsThat would have been frustrating both physically, mentally and emotionally. I’m not sure how people like yourself get through situations like that and I consider myself mentally tough. Thanks 🙏🏽
Thank you. That’s a bit of a journey. Hope you get through the next challenge well 🙏🏽
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