Spinal Stenosis & Spobndylolisthesis - Surgeons vs Pain doctors

@lizann45 Linda K, Welcome to Connect. It's good that you have had 2 opinions about your spine because as a patient you need to know if any surgeon you see is on the right track. There can be variability in how they see things and what procedures they would advise. Sometimes we don't hear what we want to hear and that comes as quite a shock. That is where some knowledge is helpful to understand what the risks are of not fixing a problem that can be fixed surgically if you are a candidate. Make sure to always ask that question of your doctors.

Spondylolisthesis is the slipping of one vertebrae past another one because the disc between them is weakened and not holding them in place as it should. A disc like that doesn't heal itself, and that problem can get worse. Effectively when it slips, the spinal canal gets smaller likes beads on a string that are offset and pulling in opposite directions.

Stenosis is the narrowing of a passageway and that can happen in the central canal where the spinal cord is, or in the foramen which are the spaces between vertebrae where the nerve roots exit the spinal cord. If you have both central canal stenosis and slipping of vertebrae, you've got 2 things working on compressing your spinal cord. Often that may be accompanied by a disc that has herniated into the canal and bone spurs that grow there trying to stabilize it. The spinal cord is pretty unforgiving of physical insults, and with enough pressure, the nerve cells start to die and dissolve in the spinal fluid leaving a mottled appearance on an MRI. That can be permanent damage resulting in disability to whatever part of the body it was serving. Also consider what happens with aging, and how will something get worse in 10 or 20 years. There is also a ligament up the back of the spine that can enlarge and also press on the spinal cord.

Compression of the spinal cord can cause all kinds of weird and diffuse symptoms that can confuse doctors because you don't know what part of the cord will take the hit as it floats in the spinal fluid. It could cause gait disturbance and walking with a limp as it did for me, or problems with functions of the bladder or bowel. I had bone spurs pressing into my spinal cord, but it was decompressed before permanent damage occurred.

I can also tell you that my experience was that spine fusion surgery wasn't that bad for my one level C5/C6. Compared to the broken ankle that happened a few years later, spine surgery was a lot less painful and an easier recovery. How much listhesis did you have? What levels are affected? What are your concerns about fusions?

It is grade 1/2. My dilemma is do I go with the non-invasive surgety (Minute Man or Mild) that pain doctor is suggesting or go with the more invasive spinal surgery.

The levels affected are L4 & L5 but also I'm concerned about the osteo in the spine which is why one pain doctor said no to the Vertiflex. Are you familiar with the Minute Man procedure?

Thank you.

So your surgery was in your neck area? Mine is the lumbar spine.

looking for advice or info on the minute man procedure for my spine problem vs open surgery. has anyone had this procedure and if so, the results?

I had the Mild....total failure and received what felt like an electrocution when he cut nerve by accident. Felt fine for 2 weeks then all the pain returned. Had the Minuteman with a new doctor. Same result. Feel great for 2 to 3 weeks then full pain levels back. The surgeons mock these minimal invasive procedures for a reason. But the pain specialist surgeons will promote them for the financial gains and don't kid yourself otherwise.

I had a surgeon tell me several years ago that if I had any major pain to have spine i needed surgery asap. I saw a pain Dr where I am now living, & after many shots that didn't work he told me how back pain is so common & nothing can be done, at least for me. I had a friend who had unsuccessful back surgery that made her worse. I have found that OMT'S have saved me, & insurance pays. I get gentle version. I have had male or female DO Drs as the only ones trained to do this, not all DO Dr do this, so if you find one, you are lucky. They just lightly move my arms, legs, feet to help straighten pelvis, which is a problem for me, also to help on my neck usually takes 15 mins & I am wiped like having a massage. I go hope & sleep for a few hours.

@anniemaggie Pelvis alignment is very important, and it does cause back or leg pain if it is out of alignment. My physical therapist adjusts my pelvis too. My PT also does myofascial release to stretch out the tight fascia that just keeps on pulling things out of alignment, so it allows my body to move properly.

This is our discussion on myofascial release if you would like more information:

— Myofascial Release Therapy (MFR) for treating compression and pain:
https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/
Have you heard of or tried Myofascial Release Therapy?

Well, for now not having surgery nor non-invasive procedures. Went to a new pain doctor and he did some epidurals of my lumbar spine. This is the first time that when having this done, I felt a strange sensation in my legs. I've had leg pain before this (right calf) and after the epidurals, for now, my leg pain has subsided and my back feeling pretty good. I am still doing my exercises and physical therapy which I feel helps too. He must have found the right nerve that was giving me the leg pain which I'm happy for. Because of my osteoporosis in my spine, he is hesitant now to do the minuteman procedure. Doesn't want to cause a fracture. So we are going to see how long the epidurals last for now. Definitely no surgery which two surgeons suggested!

lizann45

My neurosurgeon proposes coflex.
I've heard mixed reviews...

My spine doctor had offered me Intracept surgery in January. I have all the "S" problems in my lower back. I use S to describe all the words besides stenosis that I can't spell. Any way the brochure and checking data thru the internet describes a different version of nerve abalation. Instead of burning the ends of nerves on the outside of the disc, the surgeon uses radio active Lazer type method going directly inside to the middle of the disc if I understand it correctly. He will hit S1 thru S5. Outpatient home same day...sore for about 10 days and succsss rate is about 79%. I've tried every non surgical method and at 74 I'm in horrific constant 24 hour pain relying on Norcal alternating with 1000 MG of tylenol. I'm not sure if this procedure is related to what you need, but I refuse and doc agrees not to have major back surgery, fusion etc. All my friends said that surgery did not work and caused more discs needing surgery. Try Google Intracept spine method and see if this applies to your needs. I'd prefer better success rate but I"m running out of options and willing to give it a try.