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 ,

J

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@jmendoza1

Thanks Colleen.

Agree with the reminder and that different folks have different strokes!

I’ve received a different medical advice, which pushed me down the path of further research and testing different approaches.

Also comfortable that one very reputable surgeon advised against fusion at this stage. Advice taken with arms wide open!

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Here is Pic tire

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@colleenyoung

Vanessa, do you have a personal experience using ZTLido (Lidocaine)? How did the patches and the cream work for you? When do you use one over the other or in combination?

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Here is a picture they are pretty big Fit across my lower back lumbar area very well , you can even cut them in half for smaller areas , I do that for area down on side outside of my foot from nerve damage , read further down in thread fir explanations on how to use Sorry I am new at this lol Feel better soon my friend Vanessa

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Actually the surgical techniques have changed tremendously for the better. In 1988 I had what you have in after a fall during an earthquake exacerbated my spondylolisthesis L5/S1 and fractured my L5 lamina on right. I was fused L4-S1 with stainless steel plates and screws, which was the standard at the time. I have a host of complications from these plates but the pain of removal and reimplanting new titanium cages at age 70 is a no. But if I needed it now I’d have it in a heart beat with the cages. I know numerous people who’ve had this procedure without issue. As the writer pointed out by not having any correction done early her back continued to deteriorate and here you are on narcotics for chronic pain. Our bodies all breakdown eventually and we shouldn’t ignore it when it needs help.

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I was diagnosed with Bilateral Pars defect L5 s1 with grade 2 spondi in May 2022. Like you I had a hard time accepting what it all meant and the impacts it might have on my life. I have gone through many of the conservative methods (PT, Medication, Epidural). The PT and related exercises have helped tremendously, especially in conjunction with anti-inflammatory medications. But they have not been 100% effective. Recently I tried an epidural and that lasted about a week. I am wrestling with what to do next and was wondering how you are doing?

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@pdhspondi2

I was diagnosed with Bilateral Pars defect L5 s1 with grade 2 spondi in May 2022. Like you I had a hard time accepting what it all meant and the impacts it might have on my life. I have gone through many of the conservative methods (PT, Medication, Epidural). The PT and related exercises have helped tremendously, especially in conjunction with anti-inflammatory medications. But they have not been 100% effective. Recently I tried an epidural and that lasted about a week. I am wrestling with what to do next and was wondering how you are doing?

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Howdy - sorry to hear.

I have had a few ups and downs but a lot more ups lately.

For starters I’ve got into a routine of reformer Pilates (small group and personalised session last six months) at least once a week, I’ve lost some weight but not as much as I want too (I fluctuate), cycle 2/3 times a week and recently started to jog again - I had a bike accident which injured my shoulder so I could do Pilates or Ride for a month and a bit.

I haven’t had the nerve issue or issues with my legs in a while. There are moments where my back has felt tender but it’s probably due to carrying a heavy pack or sitting down too long. I started to get some nerve issues in my wrist but unsure what it was related to, which could have been desk set up, work stress, MTB set up. Hard to tell, but I am seeing a neurologist to check it’s not carpal tunnel or anything else. FYI - since I finished my project and changed projects to a new client the nerve pain in the wrist has disappeared. I was on the same project with the same client when I discovered Spondylithesis - I am not saying there is some correlation but books I have read would say there is a direct relationship between the two. Food for thought.

I feel the biggest contribution to my improved health has been Pilates, no running for a long period of time (help body recover) and stress reduction / management. Ahh also I’ve cut alcohol out the last two months and I have felt so much better

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Thanks for the update. I too started a weight loss program. I went the swimming, walking route and mixed in the exercises that I learned in PT. The epidural lasted only a week. I may have aggravated it early when I started jogging again. I will give the epidural another try but go easier on the jogging and see if the epidural lasts longer.

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@pdhspondi2

Thanks for the update. I too started a weight loss program. I went the swimming, walking route and mixed in the exercises that I learned in PT. The epidural lasted only a week. I may have aggravated it early when I started jogging again. I will give the epidural another try but go easier on the jogging and see if the epidural lasts longer.

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Have you tried Pilates? Give Pilates a go…. Honestly changed my life and I’m an endorphin junkie.

I had a PT but he pushed me down the wrong track and aggravated my back with certain weights.

Have you tried treadmill jogging or the cross trainer?

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Everyday I do PT exercises, 1.5+ miles of swimming, weights, and 2 miles jogging. Once a week I do 20 minutes of interval training on the elliptical. I will look around here for a Pilates studio and give it a try. My family has already told me that I will not be allowed to do some of my more extreme activities, this summer. 🙂

Thanks

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My situation is a little different. I have a bulging disc at L4-L5. For a few years, I could control the pain with PT, lidocaine patches, icing, and pain relievers like Diclofenac, then Meloxicam. The diclofenac topical cream or CBD cream would often work. But then I started getting severe bilateral shin pain, not related to exercise, but sometimes related to exercise if I took long strides. It felt like my lower legs were breaking. I also had pain on the lateral muscles on both sides. One day a Nurse Practitioner whipped out a reference card for Dermatomes and said, "That's caused by something in L4-L5." I had been diagnosed with a "slightly" bulging disc years before, but the doctors who saw the MRIs said it wasn't something to worry about. Well, either it had progressed, or an MRI lying down with my legs bent wasn't going to show what was happening when I was standing or sitting.

When I had an episode that wasn't responding to 5 days of lidocaine patches and 1000 mg of Tylenol, I saw my primary care doctor. She said, "I want you to try gabapentin." I wasn't too happy with the side effect profile, but after the first dose of 300 mg, the pain disappeared. Unfortunately, at that dose I had severe dizziness that only improved to moderate dizziness after a week. She changed the prescription to 100 mg 3x/day and I'm now trying to find that sweet spot of pain relief and low dosage.

I don't know if you've tried gabapentin already. It's not a drug to take without seriously considering the side effects. Also, one develops a physical tolerance rather quickly, which means that if you want to stop it, you have to taper off. But, after reading about peoples' experiences with surgery, I'm glad I am trying it. I might be able to hold off surgery with it. I do worry about nerve damage, so I'm having physical therapy now to strengthen my core muscles to try to help prevent further bulging.

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@pdhspondi2

Everyday I do PT exercises, 1.5+ miles of swimming, weights, and 2 miles jogging. Once a week I do 20 minutes of interval training on the elliptical. I will look around here for a Pilates studio and give it a try. My family has already told me that I will not be allowed to do some of my more extreme activities, this summer. 🙂

Thanks

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Very smart family 😜

I haven’t told my family about my recent adventures 😂

I’ve cut back on the running as now I am back on the bike again - shoulder has recovered from the accident. Also started to feel a bit tender in the lower back over the weekend, but unsure if that was relayed to the sudden drop in temperature. It will be interesting to see what winter holds.

I’ll aim for Pilates x1, cycling x3, run x1 and stretch everyday each week. I’ll see how the body holds up

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