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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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I haven’t jumped on the serious medication yet and haven’t had the need to luckily.
I was told by another neurosurgeon that I wasn’t doing any nerve damage. He said I would know if I was doing nerve damage in which the paint would be quite painful.
I’m glad you trying alternate treatments! Keep working on the core and healthy diet.
I can’t believe how close I was to getting surgery - so close… I honestly read on forums and research so many articles and comments, the amount of positive outcomes vs negative outcomes from fusion is outstanding. My observations is about a less than 5-10% positive story rate.
I guess you hear about the negative stories more.
How are things going these days?
I was doing better for a while then felt/heard my spine shift again. The left leg seems to have no ill affects now, but the lower back aches more and the right leg only allows me to stand for a few minutes and even walking has become a limited exercise, about 10 minutes before the pain forces me to stop. I did some personal testing on my walking. If I walk below 3.2 MPH the pain will come in about 10 minutes. Between 3.2 and 3.5 I can go about a mile. Over 3.5 I can get about 2 miles before I have to stop. That was all done on a treadmill.
I have finally gotten comfortable with the idea of moving forward with surgery, even though my new surgeon was pretty frank and said that eventually I will need additional surgery, because of my back adjusting to the new distribution of support. It may be 1 or it may be 10 years, but it will happen.
I am continuing to exercise and work on my weight and core. Unless there is some vast improvement with the conservative methods I will do the surgery just after the first of the year.
@pdhspondi2 I am wondering why there is a difference in your endurance on walking and why a faster speed buys you some more time before pain sets in? That seems to be opposite of what I would expect. What comes to my mind if you want to work on core strength is a therapeutic horse back session. There are facilities that essentially do physical therapy while you are on horseback just at a walk assisted by therapists. It may or may not be helpful to you, but it is a way to work on core strength. I own a horse and do trail riding and this helps my core strength a lot. After I had cervical spine surgery, trail riding helped me rehab because of building core strength at all the levels below my fused level, so it improved my posture and took pressure off the spine.
My doctor was not surprised that standing or slow walking can aggravate my leg pain. In fact when I first visited him he asked if I needed to support myself with a grocery cart as I walked down the isles. So, to me it was expected.
Your horse therapy sounds interesting. Having retired to The Lake Of The Ozarks, not sure where I might find it.
@pdhspondi2 I did a search and found this website where you can search for certified horse equine assisted therapy places. I selected Missouri on the left side, and scrolled down to see lists of centers. There seem to be more listed below than on the map if you keep scrolling.
PATH International
https://pathintl.org/find-a-program/
We also have this discussion on Connect.
Just Want to Talk- "Equine therapy is horses helping people how do horses help?"
https://connect.mayoclinic.org/discussion/equine-therapy-is-horses-helping-people-how-do-horses-help/
I know just sitting on a walking horse with good posture helps build core strength because you have to counter the hip movements of the horse with your back muscles so it is like you are waking without your feet on the ground. If you are not familiar with horses and riding, someone should control and lead the horse so you can work on balance and sitting up tall with good posture. Only you know your capabilities and they do this with disabled individuals with spotters next to the horse in case bad balance would cause someone to start to fall. You need a calm horse too. There is probably a lot more to it than that with a trained therapist and a lot of riding a horse is by feel and awareness.
Sometimes my pelvis shifts out of alignment, and recently it happened while I was trail riding (walking) and it sent a pain from my groin down my leg. I had to get off my horse and do an exercise to realign my pelvis that my physical therapist taught me, and then I could get back on my horse and finish the ride. That never happened before, but if you have similar issues, riding a horse may not be good. You may be able to use a big therapy ball and sit on it simulating a walking motion, but please ask your medical professionals what is right for you and safe to do.
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1 ReactionThanks for the information, I will look into it. My doctor and therapist agree that good posture and a strong core is essential for success.
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