Spondylolethesis (sp ?) L4/L5...Information, please

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MT Lady
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Date Joined Jul 2008
Total Posts : 969
   Posted 10/19/2011 8:43 AM (GMT -6)   
Hello,
I am new to this forum, but not new to the website. I have fibromylagia and mainly spend my time there. I have had back issues for almost 30 years...the usual DDD, spinal stenosis, sciatica and now spondylolethesis. The pain was severe enough that I went to see an orthopedic spinal surgeon yesterday. He took an xray after looking at a two year old MRI and said it has significantly worsened. I asked if he could "fix" it...I've tried PT, epidurals, rest and I'm at a point that I can't stand the pain; I don't want to live like this any longer. He said the surgical procedure is classic, "textbook"...something he does on a daily basis and gave me a 90% success rate.
So, now I'm wondering what to do. I am not one to rush into surgery. I've heard the horror stories of low back surgery. Can someone give me any information? Is this a condition that can improve on its own? I don't mean it will "fix" itself, but the pain will lessen in time? He did tell me my lower back is now curved at that point, like a backwards L, and showed me the xray.
He wants me to come back next week, get an MRI, bring in my list of questions and we will consult.
I am 60 years old. I have been an avid walker all of my adult life. I have three Golden Retrievers that I care for and volunteer for a Golden rescue group. I don't want to live my life lying on a couch.
Any information you can give me is very much appreciated.
thanks so much
Miriam

momtofourangels
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Date Joined Apr 2010
Total Posts : 2261
   Posted 10/19/2011 6:36 PM (GMT -6)   
Hi Miriam

First I want to say welcome to our chronic pain forum. We have a lot of supportive and caring members here, so you've found a great place for support and information.

I have back problems as well, although I haven't had any surgery. I just wanted to let you know that I sympathize with the pain you're going thru. I hope you can get some relief really soon. I'm sure you will be getting lots of replies, just be patient as everyone is dealing with their pain well.

I wish well. Take care.

hugs
Loretta
Dx: osteoarthritis, bursitis in left hip, Osteoarthrits in right hip, compression fracture in thoracic spine due to falling on frozen ground March 2001 , ddd, spinal stenosis, bone spurs, osteoarthritis in spine, osteoarthritis in both knees
Meds: Fentanyl patch, oxycodone, otc: BenGay, Tylenol Arthritis on occasion

MT Lady
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Date Joined Jul 2008
Total Posts : 969
   Posted 10/20/2011 1:23 PM (GMT -6)   
Thanks for welcoming me to the group Loretta. I hope I can manage this pain as well. It seems a bit better today. I go for an MRI tomorrow and then consult with the spine surgeon next week. Guess we'll see what he says...I'd be interested in knowing if anyone else has dealt with this and if surgery was their only option. I hate to rush into surgery
thanks again
Miriam

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16273
   Posted 10/21/2011 11:27 AM (GMT -6)   
Hi Miriam and welcome to the CP forum. One thing I would like to say is that most of the people here at this forum that have had surgery are not going to be the ones to say oh yes, have the surgery, if theirs had been successful they would not be hanging out here.

I worked as a paralegal for a plaintiff law firm for over 20 years, mainly worker's comp claims and personal injury. Over that span of years I saw thousands of people have neck & back surgery and for the most part they were successful surgeries.

Here is what I would tell anyone facing surgery, get a second opinion and let it be with the very best neurosurgeon you can find. If necessary get a 3rd opinion, it certainly will not hurt. Most surgeons will want a current MRI in hand before seeing you, so do have the MRI done as this orthopedic has recommended. Depending on the outcome of that, will determine exactly what type of surgery is recommended. If you are not interested in a 2nd opinion, ask to speak to a couple of the drs patients that he has done surgery on, nothing like hearing straight from the horses mouth about the dr.

This dr is sure giving himself a high grade on the pain reduction number, that scares me a little, actually a lot. Do your home work and find out everything you can about this dr, its easy to do.

Personally speaking, I would not let anyone but a neurosurgeon touch me as far as surgery goes. Those guys are better educated in the nerve areas than an orthopedic, ortho's are more into the bones & structure. I always saw better recoveries and shorter recoveries when a neurosurgeon did the surgery.

Good luck.
Moderator Chronic Pain Forum

MT Lady
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Date Joined Jul 2008
Total Posts : 969
   Posted 10/21/2011 11:55 AM (GMT -6)   
Thanks SO much, Straydog, for sharing with me and yes, I guess you are right, they wouldn't be here if all went well. As far as who to do the surgery, back in 1988, I had C5/C6 microdiskectomy done by a neurosurgeon because my sister is an RN and recommended that it be done by a neuro for the same reasons you listed. Now I'm being told by this doctor and a few other people that I know that the route to go today is ortho because they have become so specialized. The dr himself told me "this is all I do, I have been trained to do orthopedic spinal surgery"... and I guess he has to an extent convinced me.
I have an appt with him on Tuesday, to bring in my MRI and to discuss questions. I'm also dragging my husband along, for two extra ears but I'll also have a pad of paper and pen to take notes and ask a LOT of questions. One of the things he told me was that he is considered a VERY conservative surgeon, that he turns down people every single day that are begging for surgery to get rid of their pain, so I shouldn't feel as if he is "knife happy"... In the meantime, I had the MRI this morning and I'm in more pain now ... I've had 4 or 5 MRIs before...never had I had one that was as loud as this one...this is a newer one, higher tech, clearer views but man, was it loud, even with ear plugs in, and just having to lie on my back for 30 mins, well I don't have to tell anyone here about that...going to lie down now
Thanks so much for sharing, it means a lot to me,
Miriam
Fibromyalgia, Osteoarthritis, scoliosis, DDD L1/L2, L3/L4, L5/S1, sciatica, hypothyroidism.

MT Lady
Veteran Member


Date Joined Jul 2008
Total Posts : 969
   Posted 10/21/2011 12:02 PM (GMT -6)   
One more thing...I did Google the doctor and also checked out his CV on the practice's website. His education is from some of the top schools in the country. He's been performing spinal surgery for 9 years. He has NO malpractice, NO complaints against him, his record is pristine. But I think you make a very good point about neurosurgeons and after my appt on Tuesday, I will make an appointment with a very very good neurosurgeon. thanks again
Miriam
Fibromyalgia, Osteoarthritis, scoliosis, DDD L1/L2, L3/L4, L5/S1, sciatica, hypothyroidism.

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1235
   Posted 10/21/2011 3:40 PM (GMT -6)   
Hello Miriam,
Yes, I have had the exact surgery that your ortho surgeon is recommending, which I am assuming is a fusion of L4-5.
I have to tell you that mine did not turn out well, but I also had other problems at that level and above and below L4-5 that were not addressed at the time of surgery that resulted in my having such a terrible outcome. So please take that into account when considering surgery.
Both a neuro and ortho spine surgeon who is fellowship trained and certified have completed the same training, just in different specialities.
The spine is a complex web of the spinal cord, vertebre, ligaments and tendons, as well as nerve roots that exit each spinal level in pairs. One nerve root exits on each side of the vertebra at the different levels.
An xray unfortunately is not going to tell you whether or not there is compression of the spines nerve roots. That can only be seen through MRI's and CT scans. A spondylolysthesis ( spond-ee-lol-lis-the-sis) is the slippage of one vertebral level over another one. The degree of slippage determines what, if anything needs to be done. There are 4 degrees of slippage- the first degree is a slippage of less than 25% of the vertebra's width, second degree is 50% or less and more than 25% , third degree is more than 50% but less than 75%, and the fourth degree is more than 75% but not 100%.....The reason that you are having trouble standing and walking is because the slippage causes the spinal nerves ( it is no longer a cord per se at the lumbar area of the spine- but it is instead the nerve roots before they pair off into the foramina- little holes that allow the nerve root to exit the spine proper), to be tugged upon by the vertebra's slippage. The more the nerve roots are tugged upon, the more the nerves become impacted and can be compressed.
A fusion would bring the vertebra at L4-5 back into the proper spinal alignment, which would also relieve the tugging on the nerves. This should fix the problems, and after recovery time, you should find that you are able to walk, shop and live your life without the problems that you are currently having.
I do want to encourage you, that the majority of spinal fusions do turn out well. That is the reason that they continue to do them. On forums , unfortunately, you find people like me who had problems that may have caused or contributed in some fashion to the surgery not turning out as planned. I am one of them.
I would do as Stray recommended, first, have the MRI and see what the report says and what the recommendations are from the surgeon you have seen.. It seems that you are comfortable with him and believe that he has the credentials to give you his best result.
But, you should also consult with a board certified spine neuro surgeon and see what he says. Don't be surprised if you find that you get slightly different recommendations from each surgeon. Since spondylolysthesis is a "structural " problem , at least so far, if you are comfortable with the ortho, I would tend to go with him.......
If I can be of any further help, just ask away.
Sandi M

MT Lady
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Date Joined Jul 2008
Total Posts : 969
   Posted 10/21/2011 8:55 PM (GMT -6)   
Dear Sandi,
Thank you so very much for taking the time to explain everything so well. I did have the MRI today and it was done in a "T1", I think that is what it was called...suppose to be even more clear than other MRI images but man, was it loud. I've had 5 or 6 before this and none of them came close to the noise of this machine.
In any case, I am curious about your outcome, the other issues you have. I have seen, over the past 20+ years, rheumatologists, pain specialists, orthopedic doctors and physical therapists. I've had numerous xrays and MRIs. I've been told recently by the rheumatologist that I have facet joint pain, sciatica, and several herniated disks at different levels, in addition to scoliosis and stenosis. I do plan to bring a list of questions on Tuesday to the ortho spine surgeon. I'm curiious if you were told before the surgery what your outcome would be, based upon your other issues?
The pain is not only debilitating, it is depressing. I'm so tired of it taking over my life. I'm actually not looking forward to surgery at all, it's not what I really want to do. I just don't think there are too many other options. I do plan, though, to at least get a second opinion from a neurosurgeon.
Again, thanks so much
Miriam
Fibromyalgia, Osteoarthritis, scoliosis, DDD L1/L2, L3/L4, L5/S1, sciatica, hypothyroidism.

mrsm123
Veteran Member


Date Joined Dec 2007
Total Posts : 1235
   Posted 10/22/2011 12:19 AM (GMT -6)   
Hello again Miriam,
You're so very welcome. I was afraid after I'd posted all of that, that it might just confuse you. I know when things first went truly south with my back, the words alone confused me, then trying to understand all of the terminology, structures, etc, just added to my already muddled ,pain filled mind.
The T 1.5 is the strength of the magnet in the MRI machine. The magnet spins and causes the water in your body to fall into patterns, which gives us the images that they are looking for. The strength of the magnet helps to make sure that the water molecules line up and the images are clear. I hate how loud they are, and how long the MRI 's take compared to the CT scans but they each show different things and you may find that you are also sent for a CT scan, depending on what they see on the MRI images. Don't be too worried if they do, they just are looking to confirm or disprove nerve compression and bone density in the spine, and check out the other structures. Some are seen better on MRI ( nerves, disc hydration, etc.) and bones and structural images with CT.
Before my first surgery, I had herniations at L2-3, L3-4, L4-5, L5-S1, as well as the spondylolysthesis, nerve root compression at all of those levels, and some pretty severe spinal stenosis ( which is the compression of the nerve roots in the spinal canal). For some unknown reason ( I am guessing that it was the length of the surgery to repair just the L4-5 area and spondylolysthesis ), my surgeon didn't fix the stenosis which was worst at L2-3, L3-4 and L5-S1. My original surgery was well over 6 hours long and was "the worst mess that he had seen in some time". When I woke up from surgery, I was numb all from my hips down, buttocks, private areas, legs, feet, etc...and the pain- I can not even begin to describe it. They had to move me on a backboard from my surgical bed to a regular hospital bed and 10 did not even begin to come close to the pain levels that I was in post op.....now I know that it was because there was bleeding into the surgical bed, as well as severe swelling post op, which all led to the nerves roots, and the nerves in the canal being compressed more than they already were.....which caused what is called Cauda Equina Syndrome. It is supposed to be a rare complication of back surgery, but given my degree of compression pre op, it should have been something that they watched for. They didn't and sent me home that way....as the days, weeks and months continued, instead of getting better, I was loosing my ability to walk.....fast forward 17 months, and no answers as to why it was going the way it did, I sought out other surgeons and finally was told what happened post op.....I wound up having to have a salvage operation to try to minimize my failing ability to walk or even stand for more than a few minutes at a time. They also had to replace two screws that had loosened and were backing out of the vertebre, and added something called bmp that is supposed to guarantee fusion ( I didn't fuse successfully the first surgery either). I was told by my first surgeon that he expected me to fuse fine, and recover completely.
Now, I am facing a third surgery because the already severe compressions at the levels that were never repaired have worsened so that my canal is only open to a diameter of 3.4 mm and the covering of the spinal cord is adhered to the vertebre from L2 down.......the last two surgeons that I consulted with, have said that if I don't have surgery, it is only a matter of time before I become paralyzed. A wrong move, one day will do it.....
Now, please don't let my story scare you, but I know that it has on some level. The majority of spine surgeries turn out very well, and once people have recovered disappear from forums like these because they are out , busily living their lives. Bringing a list of questions is a great idea.......I did the same thing.
Some of mine were -
The name of the surgery?
What level (s)-
Entry point (s)-
Length of time of recovery-
Any special equipment that I would need once I came home?
What hospital?-
How long would I be in the hospital?
When would I start physical therapy?
When would I see him again once I was discharged?
How long until he expected to see signs of fusion?
Would I need someone to stay with me post op?
Any restrictions?
Since you are already being treated for pain, I would ask him if he will manage your pain medication needs post op?
how long does he expect you to need pain medications?
What does he consider a successful surgery? ( You might be surprised to find what you consider successful is not the same as what he does)
Does he expect you to make a full recovery and how long until you start to notice improvements?
What should you watch out for post op? Any red flags that you should call him for?
What if you choose not to have surgery? What are the long term effects of not going ahead with it?
how bad is the spondylolysthesis?
Any other spine problems on the MRI? What about those?

Stuff like that.....
I do know what pain takes out of you, it is stressful, and saps so much energy, time and ability from us. I hope that once you do have surgery, assuming you go ahead with it, that you are quickly back to living a full life.
Motorcycle accident 1992, Back problems from 92 to 2005. August 2005- early 2006- Chiropractor care
March 2006- consult with surgeon -PLIF/TLIF L4-5, spondylolysthesis, canal and foraminal stenosis, multiple herniations
Post Op Cauda Equina Syndrome
Revision August 2007- salvage op
March 2011- 2nd onset of Cauda Equina Syndrome
Needs surgery to prevent paralysis
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