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Forum Name: Spinal problems and back pain

Question: Grade 2 anterio-listheseis of L5 over S1


 need-advice - Sat Dec 05, 2009 3:28 am

hi,
i am a 20 yr old boy and have bad back trouble since the last 4 years.i am unable to stand or walk for more than 5mins.my lower body(below my waist)goes numb,other symptoms include clicking hips and spine,shooting pain in the lower back region.
Below is the report of the MRI test conducted on 6-Jan-2006.

Grade 2 anterio-listhesis of L% vertebra over S1 noted with bilateral spondylolysis.Resultant pseudo bulge causes severe compression of the thecal sac and bilateral exiting nerve roots.
Disc dessication and diffuse posterior disc herniation is noted at L4-L5 level encroaching both the neural foramen.
Significant thickening of the posterior longitudinal ligament noted at D12 to L3 level.
Sever facetal arthropathy noted at L5-S1.

I have consulted a few Orthopedicians and all of them adviced surgery.
is there a way to treat this disease without going in for surgery.may be physiotherapy or something.
 Dr.M.Aroon kamath - Thu Dec 10, 2009 11:49 am

User avatar Hi,
'Listhesis' means to slip or slide. "Spondylolisthesis' refers to sliding of one vertebra over the one beow it. This could be forwards (anterolisthesis) or backwarda (retrolisthesis).

One well known way of classifying this condition is as
- congenital (dysplastic),
- spondylolytic (isthmic),
- degenerative,
- traumatic, pathologic, or
- iatrogenic (ex, postoperative).

In Isthmic Spondylolisthesis: usually the L5 slides over SI vertebral segments and present with L5 nerve root compression or tethering the L5 nerve root by anchoring it to the anteriorly displaced vertebra (traction).

Degenerative spondylolisthesis usually occurs between the L4 and L5 vertebral segments (L4 slides in relation to L5).

Most patients with spondylolisthesis are asymptomatic.

Symptomatic individuals usually present with low back pain, and this is usually attributed to isthmic or facet pseudoarthrosis or disc disintegration. Rarely, patients will also have radicular symptoms due to involvement of the spinal nerve roots 9pressure or traction).

Neurological signs are unusual, and are generally limited to sensory changes in L5 dermatomal distribution. Severe anterolisthesis can stretch the entire cauda equina over the border of the lower vertebral body and can result in neurogenic claudication, perineal pain, perineal numbness, or bladder or bowel dysfunction. Any neurological deficit necessitates further evaluation to exclude other more serious pathologic processes.

In general, management of patients with this condition depends on a good number of factors such as...
- age of the patient,
- the symptoms,
- neurologic examination,
- bone quality,
- stable or unstable anterolisthesis
- co-morbid conditions & overall health.

Usually most orthopedic experts recommend a non-operative management to begin with.Customized exercise and pain management programs to help the patients to get back to as normal as possible pain-free life. These programs generally (2-3 times/week ) last for approximately 1-2 months based on individual response. These consist of electrical stimulation,ultrasound, or modalities such as massage, heat, manual therapy, ice, and graduated core stabilization and strengthening exercises to recondition the back and abdominal muscles.

Re-aligning the spine by postural training, ergonomic changes to decrease straining at work, injury prevention, back safety education on proper lifting and repetitive motion, support braces as needed, breathing/relaxation techniques to reduce pain & muscle tension and, and lifestyle modifications are other strategies often employed.

Operative management may be needed in some of the following situations
- If a trial of non-operative management fails,
- if dynamic radiological assessment shows excessive abnormal mobility of the involved verteba (during flexion and extension),or
- if there is progressive neurological deficit.

In your case i do not know if the services of a physiotherapist have been sought so far (recommended by most).Whether you need surgery or not depends on the above mentioned factors. Your orthopedic surgeon perhaps is the best person to guide you.

Best wishes!
 need-advice - Tue Dec 15, 2009 1:57 pm

Thank you Dr. Kamath.That was a very informative post.
i had visited Dr. Vengsarkar in Mumbai and a couple of other well known orthopedics.All of them suggested surgery.none of them even tried physiotherapy or any other non surgical method of treatment.This was 4 years ago,after that i tried a few alternative therapies, one of which(chyrotherapy) worked.My pain had reduced considerably and i was able to continue my day to day activities without much trouble.Around six months back it started paining again.
If i stand for a few minutes my lower backs feels strained and pains a lot.The entire region below my waist i.e buttocks,pelvis region and penis goes numb.(bladder functioning is normal).
Thank you.
 Dr.M.Aroon kamath - Mon Jan 04, 2010 10:05 am

User avatar Hi,
Thank you for the update.Please follow up with your orthopedic surgeon who will be in a better position to decide if you need further imaging studies to come to a better understanding of your problem.
Best wishes! Hope you get well soon.

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