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Spondylolthesis with Neuro symptoms

AnonymousUserAAnonymousUser Posts: 49,670

Thank you in advance for any input given.
Went to pcp with pain in my right knee (sharp stabbing) and second to that a constant ache with sporadic sharp pain in the extreme lower back. MRI shows Spondylolthesis due to bilateral spondylosis at L5 relative to S1. multiplee nerve impingements, bulging discs, and a disc tear, all from L5 to L3.
With the passing of 6 months since i started seeing the doctors, and a year since the onset of the knee pain, i have been getting neuro symptoms: lack of knee jerk right leg, muscle spasms right leg, vibrating sensation in penis, anus spasming, sporadically right knee gives out when walking.
I am a bit worried that my Ortho spinr doctor is uninterested in finding / fixing problem. He thought MS and sent me to Neuro who says it's not MS. I am scheduled for an EMG in 2 days. Other than the referal to neuro, my ortho just wanted to prescribe pain killers. in my profession i cannot be in a haze, i work on peoples cars and if i forget to tighten something or perform my job improperly, lives are in the balance.
*HISTORY* I am a 31 y/o male, physical job, had a work place injury 1.5 years ago to the back, they diagnosed as a strain, no x-rays were taken. No history of back problems nor pain before this incident.

I guess what i am looking for is: am i crazy? i do diagnostic work primarily, and seeing these finding in my back would suggest the problem is there, especially with the manner in which knee jerk reflex works. should i be looking for another ortho? should i give the ortho more of money for visits while waiting for emg results? Pain management is not really an option as i won't take pain meds and don't want the problem covered up i want it cured. I saw a physical therapist i trust for core strengthening, his evaluation was i did not need it, however i would benefit from stretching and some limited isometrics so i do them both with little relief. i'm just very frustrated.
now my insurance company wants a statement from me as to what the cause of my problem is (work injury/ car accident/ other) i dunno what to think anymore.


  • I see you're still online so am going to ask a quick question and then will write more in a minute. Could you describe the pain in your knee? Is that the major area of pain for you? Do you have any numbness or tingling?
  • the knee pain starts as an ache, very minor to severe, with the feeling of an icepick being shoved from the side of the knee (side facing the other knee) and stabbing behind the knee cap, walking does not change the intensity, and my 'gate' has changed since the onset, i walk with a limp and don't know why. if i pay attention to how i walk i can walk mostly normal but revert to the limp afterwards.

    numbness or tingling is very rare, does happen but not enough to be bothersome, there is no muscle weakness involved also.
  • I was reading along until I hit the word "CURE" which caused me to change my response. I understand the point you are making, but it is important to understand that surgery is never a "cure" for a spinal problem.

    Surgery can be done to fix an instability or for pain relief. However, there are no guarantees that the surgery will have the desired outcome, and the patient will not be restored to the way he was prior to the onset of injury or pain. Spinal surgery is very different from having the appendix out, or something like that, where you have the surgery, you recover from the surgery, and you resume your life. Spinal surgery may or may not resolve the issues for which it was performed. The patient may feel this is the case, or the patient may find he is worse off or in at least as much pain as before. There is no way to know ahead of time. The patient can be shown statistics, but will not know how it will turn out for him.

    Ok, that being said...no, you are not crazy, and yes, you should get at least another opinion from a fellowship-trained spinal specialist. This can be either a neurosurgeon or an orthopedic spinal surgeon that devotes most or all his practice to issues of the back and spine. Be sure you are seeing someone outside the practice of your first ortho.

    Did you have flexion X-rays for the spondylolisthesis? This is the best way to determine the amount of slippage you have. "Spondy" in and of itself, is not necessarily a reason that surgery will be required. Some people have the condition and are not even aware of it until they have an X-ray for another reason. If your pain is coming from the nerve compression, in all likelihood, the pain meds your doctor is giving you will not help with your symptoms.

    Ask the neurologist for a copy of his report on the EMG and nerve conduction study. That way you will have it and can take it along to your new specialist. From what you have described, it doesn't sound like you are getting adequate information from the first ortho. Please get another opinion.

    As you are aware, none of us on the board are medical professionals. What you will find is much support and many generous people who are happy to share their experiences and knowledge they have acquired as a member of the "spiney" club. Please post often with your comments and questions.

    I have/had spondylolisthesis and required surgery for it. I think you have problems going on that need attention. After your EMG perhaps the neurologist (is that who's performing the tests?) could recommend a couple specialists for your consideration.

    xx Gwennie

    I forgot to add: run a search for "dermatome map" and you will be able to see which spinal nerve roots "refer" pain to which areas. This is like a road map that helps doctors know where to start looking.
  • yes my neuro is doing the emg and another test, nerve conduction i think....one is with electrode pads, and the other is with needles directly in the muscles.

    my step daughter is currently recovering from spine fusion for debilitating scoliosis at age 14, we took her to the 'best' dr. apparently he wrote the procedure for child fusions and scoliosis repair.

    anyway he saw my deterioration throughout the day and suggested a dr. rushton at u of penn. (10 hours of waiting in hospital seats made for a horrible day lol) However my step daughter is doing phenominal, gained 3.5 inches in height!
  • If I had to make a guess, it sounds like your pain is coming from a compressed nerve. It could be from a bulging disk, but more likely is a result of the spondylolisthesis. This slippage often causes a nerve root to be compressed. This could cause nerve pain that is affecting your ability to move the muscles around the knee, and will affect the reflex as well.

    Do you think the accident at work was the beginning of your knee pain?
  • i believe the Spondy is moving around, by the popping i get with trunk rotation, i was good for 6 months after the injury, then the knee pain started accompanied by nagging back pain. but i don't know if the injury and current issue are related

  • What often happens is that "something" occurs, but there is not an immediate reaction. With spondy, you can start to develop a slight crack in the bone, but it will not exhibit any symptoms. Then down the road a bit, another action (it can be something minor like a stumble, or lifting something "wrong" or twisting and lifting, etc.) will take its toll on that little crack, making it worse and bringing on the symptoms.

    At this point, I imagine it would be almost impossible to prove if the accident and the current situation are cause and effect, related, etc.

    I'm glad your step-daughter is doing so well. I would make an appointment with that specialist that was recommended. I know what you mean about the chairs. I had a lami-foraminatomy in Jan. and was not even supposed to be driving yet when my 91-year old mother ended up in the emergency room three times within a week. One of the times, she was admitted and we hung around the hospital the entire day waiting for the admittance. My back never recovered from the experience and it in effect, ruined the results of the surgery. So I can really sympathize with you!!

    I'm glad the neurologist is doing the testing. I have had both those tests. It should tell you what is going on with your knee and give you a better idea how to proceed.

    Again, I don't think I'd bother going back to ortho # 1/ Get your EMG results and find a new specialist.
  • I have read that problems with L3 of any kind can cause knee trouble.(pain or weakness) My guess is nerve compression at L3.
    I, too have had knees collapse in the back of the knee. I have L3 problems although my symptoms are far worse that yours. I also have arthritis and connective tissue damage in both knees. I do a lot of knee exercises and i can tell the difference between the arthritis and the nerve impingement pain. The arthritis causes snapping and cracking and pain in the cartledge area whereas the nerve compression causes tingle pain all over knee plus occasional collapse of muscles in the back of the knee.
    thank god your strength is still there.....and that step daughter is improving!
    good luck with it.....pete }:) }:) }:)
  • ouch yeah yer symptoms are bad, i had n MRI of the knee and it was completely clean, not even a bit of arthur visiting. which is what leads us back to my back. yes i have impingment from L5 up thru L3, at L3 it was stated as osteophytic(spelling) impingement, dunno why thats different than the others...but it's what the mri says lol
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