Another spine thread: spondylolisthesis surgery

Background info: I'm 30 now, first started experiencing back pain about 15 years ago. Skier, MTBer like everyone else here. I was diagnosed about 8 years ago with a grade 4 (~75% slip) spondylolisthesis at my L5-S1. Symptoms are both back pain and pain down the back of my legs, more pronounced in my left left. The doctors that I've seen have said that surgery was probably inevitable, but the decision would be driven by either progression of the slip or an increase in my symptoms. I've gotten a couple MRIs/X-rays since that have shown that the slip is generally stable.

Starting last fall, symptoms have changed slightly with more numbness and a couple instances of one leg giving out. The pain has increased as well. At this point, I'm thinking that surgery is going to be recommended. I have a visit with my specialist on Thursday to discuss my last MRI and next steps. I'm up for surgery now if there is a chance that it reduces the pain. Currently on ibuprofen and tramadol as required, unfortunately it's progressed from needing it once a week to daily.

Has anyone been in a similar situation and operated? Or any other lumbar fusion experiences? I read a couple threads from 2010 and 2013, it would be good to hear feedback a few years on.

Edit to give some context- here's an x-ray:
Attachment 225641

My L4 has done this off and on for 20 years, not as bad as yours, by the sounds of it, but close at times. Fusing - NO - not until you have tried every hands on bodywork, chiropractics, lasers, acupuncture, exercise and whatever. It seems most of the people I know who get fused and continue with an active lifestyle tend to start breaking above the fused area and the rods get longer and the screws more numerous with time. You don't want the knife except as a last resort. Of approximately 50 people I've known who've had back surgery, I can count the ones who are happy about it ten years later on one hand. I've broken my back a few times and believe I did quite well by refusing and avoiding the knife. You're too young to get surgery without trying alternative methods first. It's your fucking spine; don't forget that.

Thanks. I do lots of core work, yoga, have done physiotherapy, etc. Things actually aren't bad when I'm moving - the real problem is trying to sit for more than a couple minutes at a stretch. I've yet to find a way to help that but am open to trying anything at this point.

Is spinal disc replacement a possibility? Kind of a new thing I believe, and friend has had a good result from a recent procedure.

Do not opt for surgery or a fuse. Bad, bad, bad. You'll lose more range of motion and still be plagued with annoyances after the fact. Have you ever considered acupuncture and then go with stem cell treatment. You'll be good as new. Best wishes to you, nothing is more annoying than constant sciatica, pain and numbness. God bless!

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Originally Posted by ichibaneye

Do not opt for surgery or a fuse. Bad, bad, bad. You'll lose more range of motion and still be plagued with annoyances after the fact. Have you ever considered acupuncture and then go with stem cell treatment. You'll be good as new. Best wishes to you, nothing is more annoying than constant sciatica, pain and numbness. God bless!

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remember: we're always here to give uneducated advice when you need us

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Originally Posted by willywhit

remember: we're always here to give uneducated advice when you need us

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You've zero knowledge of my experience or life you little punk ass puke. OP listen to littlewillywitless for sure he is a big grown-up. Just totally disregard something that's fixed something for me in the past and that is still problem free to this day years later.

CBD cream, for real. Get some.
Go On Now

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Originally Posted by ichibaneye

You've zero knowledge of my experience or life you little punk ass puke. OP listen to littlewillywitless for sure he is a big grown-up. Just totally disregard something that's fixed something for me in the past and that is still problem free to this day years later.

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You should see a life coach bro. This hate ain't good for you. It's like my spiritual guide says "Things turn out best for the people who make the best of the way things turn out."

Now, just breath.

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Originally Posted by cmcrawfo

You should see a life coach bro. This hate ain't good for you. It's like my spiritual guide says "Things turn out best for the people who make the best of the way things turn out."

Now, just breath.

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holy shit. I guess I missed this. Itchy Brown Eye sure is a lot fun. I could go into my history of back pain due to skiing, kitesurfing, dirtbikes, etc but why not just trust Dr Browneye ? I know what it feels like to not be able to walk or sleep because the pain from sciatica has you incapacitated.let's hope itchy doesn't make it to 500 posts.

Just tossing this out there.

Spondylolisthesis at such an early age might be a sign of spina bifida occulta. Somewhat difficult to diagnose on mri or other imaging modalities. If that is the case it is only your core strength that has kept this from being a complete skip with devastating neurological consequences.

I know a lot folks on this board view MD’s as charlatans but this is worth the time and visit to a GOOD neurosurgeon to explore this diagnosis.


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If you have surgery you want a surgeon who is a fellowship trained spine specialist.
I would be leary of chiropractic or any other spinal manipulation in this situation.
Speaking as a patient and a yoga dropout, not as a doctor, some of the yoga positions like down dog can put additional pressure on the nerve roots. If yoga doesn't bother you I withdraw my objection. If it hurts but you keep doing it because it's the thing to do, I'd stop, or practice selectively.

Went to the doc- surgery recommended. The main concern is the pinching of the nerves as they make a sharp turn to get over my tailbone- the narrowing is very obvious on the MRI. One plus is that things don't seem to have moved much from the last visit, however progression of the symptoms (particularly bladder related) and potential long term nerve issues warrant doing something now (that's the recommendation).

I'm in the UK for now so still have some time to think about it while things work their way through the system but am 95% sure that I'm going through with it- still want to hear from anyone with first hand experience.

And on the yoga- I don't do anything that induces pain. Most poses are fine, lying flat on my back is undoable though.

I don't know how much "shopping around" you can do within your health system. Consider seeing a few neurosurgeons prior to surgery. Depending on your diagnosis there may be more than one appropriate surgery.

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I have had two back micro discectomys. One was to relieve "quads equine" syndrome. The other was pain down the leg. If you are having loss of strength, neuropathy down the leg, you need to get surgery. If the nerve is getting impeded, it could just die, and you will never walk the same again.
I am 17 years out on my one surgery and 11 on the other. Very happy wit the results. I had both done at steadman Hawkins, Dr Cornman who is super progressive and is known to take conservative approaches to treatment. I had a second opinion from dr Chad Prusmack, the neurologist for Broncos in Denver. Same recommendation.

Are they recommending fusion? Usually they do micro disectomy first. Fusion is a monster step. I would get a 2nd opinion.

Cbd will help with some local pain but will not decrease neuropathy in your leg.
Reach out via pm with any questions or if you want to talk about specifics.

Oh, pick up Dr John Sarnos books. There is something to be said how about his theories.

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Originally Posted by skideeppow

Oh, pick up Dr John Sarnos books. There is something to be said how about his theories.

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I think Sarnos mainly talks about straight up back pain with no clear cause. The OP here, his L5 vertebra has slipped almost entirely out of place. That’s pretty bad and not many options.
I preach putting off any kind of surgical intervention for as long as possible, but I’d venture to guess that any surgeon that sees that X-ray is going to go,that route.

Btw, skideeppow, it’s Cauda Equina syndrome....Cauda Equina means Horses Tail and is in reference to the nerve roots where the cord ends.
Also, Microdiscectomy does nothing to fix spondylolithis.

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Originally Posted by KenJongIll

I think Sarnos mainly talks about straight up back pain with no clear cause. The OP here, his L5 vertebra has slipped almost entirely out of place. That’s pretty bad and not many options.
I preach putting off any kind of surgical intervention for as long as possible, but I’d venture to guess that any surgeon that sees that X-ray is going to go,that route.

Btw, skideeppow, it’s Cauda Equina syndrome....Cauda Equina means Horses Tail and is in reference to the nerve roots where the cord ends.
Also, Microdiscectomy does nothing to fix spondylolithis.

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That's was auto correct on the cauda equine, I i didn't realize he was referring to spondylolithis as welll.

I have the same condition, although I don’t know the percent of my slip. A few years back my right leg began having nerve issues with numbness and pain. Walking became hard to do. Surgery was suggested.

I took up yoga and and have never looked back. I started with 5 days a week, and within the month pain was way down and I had a lot less nerve issues in my leg. 4 month’s in, and I was almost normal again.

After that I started going 2-4 days a week.

Recently I broke my ankle and missed 3 months of yoga and my pain did not return. I back at it now.

In the last 3 years since I started yoga, my back has only gone out once, while unpacking from a camping trip. Way less than usual.

Yoga.

Edit: I see you are doing this. The key for me was hip openers (esp on my right side) and core strength.

And, I agree with buttah. CBD cream can work wonders.

Just checking back in...rereading a few things, and saw OGs recommendation to seek a fellowship trained surgeon. And while that’s a good suggestion, some of the worst spine surgeons I’ve ever seen were fellowship trained, so it’s no guarantee....and I’ve also seen some really good ones that didn’t do fellowships, but the residency programs they came from were generally very heavy into spine. Hell, not many neurosurgeons even want to touch brains these days....not enough money in it. 20yrs ago, a lot of neurosurgeons didn’t even know how to do lumbar fusions worth a shit.

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Originally Posted by KenJongIll

I think Sarnos mainly talks about straight up back pain with no clear cause. The OP here, his L5 vertebra has slipped almost entirely out of place. That’s pretty bad and not many options.
I preach putting off any kind of surgical intervention for as long as possible, but I’d venture to guess that any surgeon that sees that X-ray is going to go,that route.

Btw, skideeppow, it’s Cauda Equina syndrome....Cauda Equina means Horses Tail and is in reference to the nerve roots where the cord ends.
Also, Microdiscectomy does nothing to fix spondylolithis.

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I was about to say the same thing. All that I can add is "spondylolisthesis".

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Originally Posted by KenJongIll

Just checking back in...rereading a few things, and saw OGs recommendation to seek a fellowship trained surgeon. And while that’s a good suggestion, some of the worst spine surgeons I’ve ever seen were fellowship trained, so it’s no guarantee....and I’ve also seen some really good ones that didn’t do fellowships, but the residency programs they came from were generally very heavy into spine. Hell, not many neurosurgeons even want to touch brains these days....not enough money in it. 20yrs ago, a lot of neurosurgeons didn’t even know how to do lumbar fusions worth a shit.

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All this is certainly true. Fellowship training is a starting point but no guarantee. There are qualified non-fellowship trained doctors in any specialty, but as surgery gets more and more specialized fewer and fewer surgeons get adequate training in the more complicated cases; the cases all go to the fellows. I did a lot of lung surgery in my training--enough to do it in my practice but general surgery residents don't get that kind of training nowadays. I assume the same is true of spine. It's very difficult for patients to truly evaluate the qualifications of surgeons except in a few specialties like cardiac where there are statistics available. I don't think going to doctors of the rich and famous or athletes is any guarantee. Look at Tiger's back, or Michael Jackson's face.

Anesthesiologists and OR personnel are good sources, although they tend to judge based on speed and OR manner, rather than outcome and case selection. The two sometimes go together sometimes not.

That xray looks a lot worse than mine.

A few more details-
The doctor that I've been seeing is a spinal fellow.
The recommendation is a L4-L5-S1 fusion, on the basis that the L5 has slipped/worn to the point that there isn't much to grab. The fusion is to support opening up the area around the back of the nerves.
Immediate next steps are another x-ray and CT to develop a more detailed surgical plan.

There aren't many options over here for shopping around, however I have a couple trips back to the states in the next few months so will try to get some input from a neurosurgeon

And appreciate the input, I knew that some of the dentists here had other medical hobbies...

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Originally Posted by orlowskij

The recommendation is a L4-L5-S1 fusion, on the basis that the L5 has slipped/worn to the point that there isn't much to grab.

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Damn. Nothing to offer other than well wishes, good luck.

From what I've heard the UK vets their surgeons pretty well compared to the US so your chances of winding up in the hands of someone who's less than stellar are probably pretty low. And in the UK surgeons are "Mister", not "Doctor", since they don't have academic doctorates (neither do most internists) but do have master's degrees in surgery. It's reverse snobbery--they don't want to be confused with mere internists. Admirable IMO. In the fine tradition of barber surgeons. Hey--I do cut my own hair so I qualify.

Good luck with the surgery. If it doesn't go well I don't want to hear about since I may be needing soon.

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Originally Posted by old goat

From what I've heard the UK vets their surgeons pretty well compared to the US so your chances of winding up in the hands of someone who's less than stellar are probably pretty low. And in the UK surgeons are "Mister", not "Doctor", since they don't have academic doctorates (neither do most internists) but do have master's degrees in surgery. It's reverse snobbery--they don't want to be confused with mere internists. Admirable IMO. In the fine tradition of barber surgeons. Hey--I do cut my own hair so I qualify.

Good luck with the surgery. If it doesn't go well I don't want to hear about since I may be needing soon.

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Huh, I'd wondered about the Mister/Doctor distinction.

I found out I can get a physician to physician second opinion through my US health system (for $$$ of course)- need to decide if that's something to pursue. Looking like ~ June for surgery so a little time to work it out.

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Originally Posted by Dantheman

Damn. Nothing to offer other than well wishes, good luck.

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Need to fuse one above and one below the problem in order to get stability.


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Originally Posted by skideeppow

That's was auto correct on the cauda equine, I i didn't realize he was referring to spondylolithis as welll.

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It's right there in the thread title.

OP, if you have surgery you will likely never be the same again and if you stay active you will likely require a fusion extension in the future. The alternative is the loss of full use of your legs and a lifetime of pain. You have a bad problem, it's kind of a Catch-22.

The advice about finding a fellowship trained spine surgeon is sound, but I've worked with some truly shitty fellowship trained spine docs too. Shop wisely.

Damn, good luck. I'm dealing with spondylolisthesis (and a synovial cyst) myself and am wondering what the future will bring, so I appreciate following this thread. I've been told surgery and spinal fusion is in my future. So far cortisone shots in the spinal column have taken me from flat on the ground to skiing again, but I know those are not a long term answer.

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Originally Posted by orlowskij

Huh, I'd wondered about the Mister/Doctor distinction.

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Apparently docs can get an actual doctorate in the UK by doing research and a thesis, like any other doctorate. The great majority don't bother; the non surgeons call themselves doctor for their ego because they don't have the balls to cut people open and faint at the sight of blood. Sad. I wish we had the same system here.

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Originally Posted by MagnificentUnicorn

OP, if you have surgery you will likely never be the same again and if you stay active you will likely require a fusion extension in the future. The alternative is the loss of full use of your legs and a lifetime of pain. You have a bad problem, it's kind of a Catch-22.

The advice about finding a fellowship trained spine surgeon is sound, but I've worked with some truly shitty fellowship trained spine docs too. Shop wisely.

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At least I'm not overthinking it.....

I got a letter from the surgeon yesterday with more details. Scans are stable but show severe stenosis, and the change in symptoms sounds like an "L5 nerve root flareup". Proposal for surgery is "L4-S1 fusion and decompression with an L4/L5 TLIF and a postero-lateral fusion following the decompression". Forecasting 6 weeks off work and 3 months to recover, though in the discussion he did say that nerves could take longer to recover. Still on track to get a CT and updated xray then tweak the plan from there.

I decided to go through with the decompression and fusion on Wednesday. I'll be leaving the hospital today or tomorrow morning. Final hardware arrangement is 4 screws, 2 rods and a cage. The lower 2 screws are through the L5 and S1 (still close to horizontal due to the degree of slip), and the upper screws are in the L4. The cage was installed between L4/L5.

The last couple days have been managed with drugs but off the morphine today. While I'm sore and extremely weak, I can tell that the nerve pain that I've had in my legs for as long as I can remember is gone.Attachment 242549

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congrats, dude

that feeling of progress is unmatchable, even through the pain of recovery

I have a little bit of that hardware in the same place.

I hope your recovery is going well!

Attachment 249643
Another one.

Thanks. Things are on track. Saw the surgeon a few weeks back- the focus now is on rebuilding my core while everything continues to fuse over the next 1-2 months. I've been on my road bike on the trainer a bit. I'm still getting pain daily but am pretty much off the meds. Going to be moving back to the states next week and need to get set up with a doctor pretty quickly to keep an eye on it.

Most importantly, when I asked about a Feb ski trip, doc said he considered it mandatory. I'm not going to be dumb about it but am pretty pumped- I'd written this winter off.

So how's it going? I've got spondylolisthesis at l5 s1 which has caused a synovial Cyst at l4 l5. I'm getting the cyst removed this Friday but opted to not address the spondylolisthesis with fusion, as my spine appears stable. Just curious how recovery is going for you.

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Originally Posted by WMD

So how's it going? I've got spondylolisthesis at l5 s1 which has caused a synovial Cyst at l4 l5. I'm getting the cyst removed this Friday but opted to not address the spondylolisthesis with fusion, as my spine appears stable. Just curious how recovery is going for you.

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Hey man. How are you? I’ve got Coflex device implant prescribed. Just waiting for approval. My spondy is not bad or they couldn’t do it. Been down for the season.

Yo 4matic! Sorry to hear you are having back troubles. That sucks. I got to ski for a while but between my back and my knees I've been shut down for over a month now.

I didn't have surgery on Friday after all as I failed the pre surgery physical because of a sinus infection! I'm now on antibiotics and surgery is scheduled for April 23. Hopefully it helps and I don't need a fusion. My new medical marijuana card helps for sure.

I had to shut it down in January. Didn’t really have to but it just wasn’t fun. Epic year too. No complaints. I’m lucky all said. Good luck and we’ll ride again with replacement parts. Keep us informed!


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