Spondylolisthesis: doctor responses to patient questions

The following explanations, insights and advice about spondylolisthesis are provided by Peter F. Ullrich, Jr., MD, an orthopedic spine surgeon and Medical Director for Spine-health.com.

Patients frequently e-mail us questions about spondylolisthesis and related back problems. While we don’t provide individual responses, periodically, Dr. Ullrich will take time to respond to the more frequently asked questions and we publish the responses in this section of the site.

Please understand that the following responses to spondylolisthesis questions represent the opinion of one physician, and are intended for informational purposes only and not as a substitute for professional medical help or advice.

Spondylolisthesis questions and physician responses

Question:

I have spondylolisthesis of L5 on S1 grade 1-2. Two steroid epidurals helped the back, leg and foot pain very much, but due to increasing weakness and muscle atrophy of my right leg/foot and numbness of the lateral part of my right foot, I opted for surgery 4 weeks ago. The numbness has been present from the outset of problems. I had decompression of L5 and S1 nerve roots and fusion of L5 and S1. I was given no guarantee on the numbness. What is your experience with numbness being corrected with surgery and how long would you expect it to take if the numbness is relieved?

Doctor’s response:

Usually the numbness from a condition such as spondylolisthesis is the first thing to start and the last thing to go away. The numbness can take up to a year to get better, or even longer. Most times it improves or goes away. If you had a lot of nerve damage (as would be evidenced by the preoperative weakness), I would probably expect that you would have some residual numbness. The bottom line is you won't know what you have until the nerve is done healing and this takes at least a year. If the numbness is still there at a year, then unfortunately the numbness is probably permanent.

Question:

What are the options for treating a facet joint that has slipped slightly forward at L-4 and L-5 (results of MRI)? I have tried Vioxx, and stretching and strengthening exercises for 3 months, but the pain continues, especially after golf or tennis or sitting, occasionally in buttocks and down left leg. I regularly have slight tingling in left foot, no known instance causing injury--seems to have developed from overuse--primarily golf. I am male, age 55.

Doctor’s response:

This is most likely a degenerative spondylolisthesis. Besides medication and physical therapy, other choices to treat the spondylolisthesis would include epidural steroid injections or a one level spine fusion. Epidural injections are easier to go through, but the surgery is more reliable. Basically, if the joint has slipped, then the facet joint is degenerated and is no longer competent to stabilize the spine properly. A fusion surgery should stabilize the unstable painful joint. Where there is no motion, there shouldn't be any more pain. Besides medications you may want to consider physical therapy and/or chiropractics. If this does not improve the pain, and it is limiting your normal level of functioning, you may want to consider epidural injections. If these do not work, a spinal fusion may be a reasonable option. Usually, surgery is only considered for patients with significant functional limitations.

Question:

After 7 weeks of X-Rays, MRI's and a bone scan, I have been scheduled for surgery. I have Grade 2 spondylolisthesis of the L4-L5 level, degenerative disc disease, spinal stenosis and osteoarthritis. I am in a lot of pain when not taking 800mg of Motrin and Percocet, especially in the morning. Until June 15th, I walked 3 mornings a week and played 6-8 hours of tennis every week. I have been doing nothing since the pain started. Are there any exercises I can do for the next 6 weeks? Swimming? Upper body weight exercises? I need to try to maintain my weight because I will not be able to do much after the operation either. I've always used exercise as a means of reducing my weight. I don't know how to eat less...and I'm bored, in bed when not working, sitting, watching TV, movies. Help!

Doctor’s response:

Generally, patients with spinal stenosis and spondylolisthesis are more comfortable if they are sitting than when they are standing. Therefore, most are able to exercise best if they are in a sitting position. Either a recumbent or an upright stationary exercise bike is usually well tolerated, as you would then be in the sitting position. The other thing to try is water walking (or aqua therapy or pool therapy). In the water, your joints are unweighted; therefore, exercising in the water does not usually create as much pain as exercise on solid ground.

What next?

If you have questions about your spondylolisthesis or other back problems, please use this site to find peer-reviewed health information about spinal conditions, diagnosis and treatment options. The quickest way to locate information on the site is to use the “keyword search” box located in the upper left hand corner of each page. Also, if you want to talk online with others who may be in a similar situation or exchange information with other patients with spondylolisthesis, please go to the Spine Forum Message Boards.

Additional disclaimer: Spine-health.com does not offer medical advice or treatment. This information does not replace the physician-patient relationship, and the information is not medical advice or treatment. It should only be considered as one physician's opinion based on an extremely limited amount of information. Patients should always seek the advice of a trained health professional for back pain or any health condition. Please note that the contents of this section have not been peer reviewed by Spine-health.com’s Medical Advisory Board.