Another spine thread: spondylolisthesis surgery

[orlowskij]

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:

[splat]

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.

[orlowskij]

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.

[SkiBall]

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

[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!

[willywhit]

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!

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

[ichibaneye]

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

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.

[buttahflake]

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

[cmcrawfo]

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.

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.

[willywhit]

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.

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.

[detrusor]

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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[old goat]

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.

[orlowskij]

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.

[orlowskij]

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

[skinipenem]

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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[skideeppow]

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.

[skideeppow]

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

[KenJongIll]

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

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.

[skideeppow]

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.

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

[Ottime]

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.

[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.

[old goat]

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.

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

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.

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.

[orlowskij]

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

[orlowskij]

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

[Dantheman]

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.

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