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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I have had symptoms similar to what you describe for years. They come and go based on what I am doing, and have not progressed. I would stop running and understand that if you live with certain limitations, things may not get worse. I recommend tai chi strongly. Disclaimer here that everyone is different so I am only sharing my own experience.

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@windyshores

I have had symptoms similar to what you describe for years. They come and go based on what I am doing, and have not progressed. I would stop running and understand that if you live with certain limitations, things may not get worse. I recommend tai chi strongly. Disclaimer here that everyone is different so I am only sharing my own experience.

Jump to this post

Thanks!

I am going to try as many alternate forms of passive treatment as I can both physical, mental and emotional options.

Will definitely look Tai Chi!

I am actually having issues finding a Pilates / core trainer. They just seem to ignore me probably because of my injury. A bit disheartening but I’ll find someone.

I just started Chiro (haven’t seen one yet) and posture management. Will hopefully lose some weight too, but I am not overweight just not at my optimal weight.

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I have a much milder form of what you describe. I was told that the bilateral pars defect was a stress fracture that led to the slightly slipped discs. In my case, a PT thought my posture may have caused the pars defect and she taught me how to stand straighter. In your case,, perhaps it was the running. My pars defects are healing well as confirmed by x-ray. I hope this information helps!

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@pacer3702

I have a much milder form of what you describe. I was told that the bilateral pars defect was a stress fracture that led to the slightly slipped discs. In my case, a PT thought my posture may have caused the pars defect and she taught me how to stand straighter. In your case,, perhaps it was the running. My pars defects are healing well as confirmed by x-ray. I hope this information helps!

Jump to this post

Thanks. My posture has never been the best since I was a kid and my family used to always make fun of my S shape. I think subconsciously I tried to correct it over life via walking, running, etc. I could have created more damage. However, my mum reminded me of a significant incident that she thinks could have caused the issue - I think she is right. I fell out of a car and landed on my butt when I was 16/17 yrs old. I totally forgot that happened - so don’t ask why or how it happened :p

I’m not sure if my par defects can heal as the slippage seems too much to correct 16mm. My best bet is to be able to delay surgery if possible. I’ll see how I go with the passive treatment which includes posture correction.

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I am 78 years old and had a similar diagnosis spondelothesis at age 35 or 36. My doc recommended exercise and weight loss, stretches, etc just as you described.
I had injured my back as a youngster playing football, had chiropractic treatments which got me back on my feet.
Finally at age 63 I had the surgery-a fusion of L5 and S1….ALIF and PLIF), as you described. I had let it go to the point where the vertibrae moved forward causing excruciating pain, mostly in my left leg.
I was told The surgery was a “success” with the exception of an infection, requiring the neurosurgeon to go back in and clean out the fluid a week later.
I recovered and was able to play golf and carry on with normal activity for about 7 years…after which the sharp pain in both legs and numbness in my foot set in. We tried epidural injections which had no effect. Doc told me pain and numbness in my foot were being caused by “scar tissue” on the nerve and the surgeon wanted to open up the site and clean the scar tissue off from the nerve-risk of paralysis was mentioned, which was enough to make my decision to get a neurostimulator. Now I am still walking, but for limited distances only, and with use of a cane.
I’m contemplating having Mayo do a spinal study to determine if all my current difficulty is caused by adhesive arachnoiditis!?!
Stimulator is no longer of any benefit, but removal requires another major surgery, which I don’t care to go thru at this age.
My advice be cautious and ask lots of questions before having a fusion. Ask about “stair stepping” - ultimately resulting in fusing all of your lumbar!!!
Good luck! Take care!

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@burrkay

I am 78 years old and had a similar diagnosis spondelothesis at age 35 or 36. My doc recommended exercise and weight loss, stretches, etc just as you described.
I had injured my back as a youngster playing football, had chiropractic treatments which got me back on my feet.
Finally at age 63 I had the surgery-a fusion of L5 and S1….ALIF and PLIF), as you described. I had let it go to the point where the vertibrae moved forward causing excruciating pain, mostly in my left leg.
I was told The surgery was a “success” with the exception of an infection, requiring the neurosurgeon to go back in and clean out the fluid a week later.
I recovered and was able to play golf and carry on with normal activity for about 7 years…after which the sharp pain in both legs and numbness in my foot set in. We tried epidural injections which had no effect. Doc told me pain and numbness in my foot were being caused by “scar tissue” on the nerve and the surgeon wanted to open up the site and clean the scar tissue off from the nerve-risk of paralysis was mentioned, which was enough to make my decision to get a neurostimulator. Now I am still walking, but for limited distances only, and with use of a cane.
I’m contemplating having Mayo do a spinal study to determine if all my current difficulty is caused by adhesive arachnoiditis!?!
Stimulator is no longer of any benefit, but removal requires another major surgery, which I don’t care to go thru at this age.
My advice be cautious and ask lots of questions before having a fusion. Ask about “stair stepping” - ultimately resulting in fusing all of your lumbar!!!
Good luck! Take care!

Jump to this post

Hi,

Very interesting story and thanks for sharing.

My numbness and tightness has improved. Still there but not as often. I also got a second neurosurgeon opinion that can highly recommend from family and reviews.

The surgeon did not recommend surgery now. He said I have no power or movement loss in my right leg or foot. Also stated I wasn’t doing any nerve damage. He thinks I’ll need surgery but it could 10-15 yrs down the rack or within the next month or so.

He couldn’t predict how quickly my vertebra or disk would deteriorate and impinge on my nerve. He was pretty confident I was born with the abnormality but just got worst with time.

He thinks I’m still young and health and should continue to manage it passively. He said I could run but that would be my risk and would speed up the deteriorating process.

My love / passion of ultra running since 2016 sped up the process. I’ve come to the conclusion that I will not run long distances anymore let alone run. It will be Pilates, swimming, easy bike riding and core/strength. I’m still finding ways how to manage mentally.

I read Dr Sarno and Nicole Sach. Both are left field and focused more on mental health and linkages with pain. It makes sense but you have to be open to it like Tony Robins.

I’m determined to give everything a go to manage my abnormality to delay surgery as long as possible and safely.

Thanks for your insights. Quite a positive forum here!

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Hi All,

It’s been a few months and I’ve picked up Pilates, bought a bike and started cycling, swimming, strength/light weights training and drastically cut running out of the program - max 20-30 min jog 1/2 twice a week. So far so good.

However, it’s no winter in Oz and I am starting to feel the back is a bite tight and tender. Is it normal to feel this in cooler seasons?

Note, I don’t have the pain down the right calf or any tingles in my lowe leg, which is good I guess.

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This is not really advice... just some comments that I know about your situation. I have had spondylolisthesis since I was 20 years old and have lived an active life much like yours by just personally figuring out how to live with it. I am now 76 and progressive arthritis is making the situation much worse. So am having to make decisions about (1) Physical Therapy (helpful so far), (2) a referal to a specialist who can inject pain killers into specific vertebrae, or (3) spinal surgery. I'm not sure how the last two treatments really work as I have not met yet with these docs. But I'm on an 8 week plan to put this all together before deciding about surgery... obviously my last choice. You are in a tough spot and I hope we can share useful information as it evolves.

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@retiredprofessor

This is not really advice... just some comments that I know about your situation. I have had spondylolisthesis since I was 20 years old and have lived an active life much like yours by just personally figuring out how to live with it. I am now 76 and progressive arthritis is making the situation much worse. So am having to make decisions about (1) Physical Therapy (helpful so far), (2) a referal to a specialist who can inject pain killers into specific vertebrae, or (3) spinal surgery. I'm not sure how the last two treatments really work as I have not met yet with these docs. But I'm on an 8 week plan to put this all together before deciding about surgery... obviously my last choice. You are in a tough spot and I hope we can share useful information as it evolves.

Jump to this post

Wow! That is a long time to live with it and gives me hope.

I don’t have the tingles in the leg anymore which is good. Tightness in calf only really occurs with a certain type of show or jogging- so could just be muscular. I’ve decided not to run / jog - only if I extremely need to due to work stress and if I have no time to ride.

I ride 3/4 times a week now - an hour each time. It helps me mentally and physically. Pilates is once a week and I have strength 2x a week. Not much success losing the weight yet - 3kg in 9’weeks.

I’m trying a lot of different treatments. Unfortunately it seems like work plays are part due to long meetings / workshops and documentation! I can’t quit work can I ? Haha

What type of surgery do they recommend at your vintage? Didn’t think they would recommend it

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@jmendoza1

Wow! That is a long time to live with it and gives me hope.

I don’t have the tingles in the leg anymore which is good. Tightness in calf only really occurs with a certain type of show or jogging- so could just be muscular. I’ve decided not to run / jog - only if I extremely need to due to work stress and if I have no time to ride.

I ride 3/4 times a week now - an hour each time. It helps me mentally and physically. Pilates is once a week and I have strength 2x a week. Not much success losing the weight yet - 3kg in 9’weeks.

I’m trying a lot of different treatments. Unfortunately it seems like work plays are part due to long meetings / workshops and documentation! I can’t quit work can I ? Haha

What type of surgery do they recommend at your vintage? Didn’t think they would recommend it

Jump to this post

J... I don't know about the surgery for my case. I haven't met with a spinal surgeon yet... as mentioned I'm on an 8 week plan of physical therapy and epidermal injections. Then will decide about surgery... last resort. I've done numerous treks (5 day, 50 miles, etc.) through New Zealand, Australia, and Canada. Sure would like to have one more of those.

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