Isthmic Spondylolisthesis Multi-Specialty Case Review

Chief complaint

Right leg pain with walking

History of present Illness

Patient is a 43 year old physician that has had years of on again off again leg pain. The current episode of pain started over one year ago. He is otherwise healthy and previously very active. He has no pain with sitting, but if he tries to walk more than a 100 feet pain will radiate from his back down his right leg and into the big toe. If he sits down the pain will resolve. Although he can no longer jog, he can ride a stationary bike without any problems. He has tried nonsteroidal drugs which help the pain, but his function is still very limited.

Physical exam

Healthy appearing 43 year old male in no apparent pain. He has pain with extension of his spine but forward flexion is not a problem. He does not have any hamstring tightness, and the straight leg test is negative (i.e. no nerve tethering). He has some weakness in extending his big toe on the right but no other focal motor deficits. There is no restriction in the motion of his hips.

Imaging studies

The X-ray (figure 1) shows an isthmic spondylolisthesis at L5-S1.The sagittal MRI scan (figure 2) confirms and isthmic spondylolisthesis at L5-S1, and there is also a disc bulge and disc dehydration at L4-L5 indicating early degenerative disc disease. The sagittal scan taken out in the right foramen (figure 3) confirms foraminal stenosis at L5 impinging on the L5 nerve root.