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retrolistheis pain??

AnonymousUserAAnonymousUser Posts: 49,670
edited 06/11/2012 - 8:37 AM in Lower Back Pain
I have had back pain, si joint pain , hip pain and radiculopathy all on the right side of my body for 2 years. I have had normal plain XR films, normal bone scan, normal pelvic CT, normal hip arthrogram. I have been to physical therapy with little improvement in my symptoms. The only thing that has subsided is my piriformis syndrome due to a year of deep tissue massage and stretching. In turn this has lessened some of my radicular symptoms, but has left me with a possible chronic hip bursitis. I recently had an upright MRI and it said my test was unremarkable except for mininmal retrolisthesis at L5 S1. Could this be causing all of my pain? I have been diagnosed with a hypermobile SI joint and am continuing to do my physical therepy at home. I have had 6 cortisome injections- si, l5 s1 epidural and caudal (some trigger points) with out relief. Should I have a discogram? A CT Myelogram? I recently took a leave from my job as an RN due to the fact that I could not wear my required lead apron or sit for our long cases. I need to get better and care for my 3 year old beautiful little girl with out pain! Please help.


  • Before you have the more invasive tests, which may or may not be necessary, I would suggest you get a flexion X-ray study and perhaps a regular MRI. This might give you more information on the retrolisthesis. A lateral X-ray, if done carefully without any rotation, is the best way to diagnose retroisthesis.

    Retrolisthesis often means there is some disc degeneration. It is often caused by injury and often results in instability of the connecting soft tissue -- muscles, ligaments, tendons and discs.

    You need to watch for any symptoms of cauda equina syndrome with a retrolisthesis at this level, as it can push into the spinal column if the posterior displacement is large enough. If you should develop any bladder or bowel problems, either incontinence or inability to pee or poop, call your doc immediately or go to the ER if you cannot reach your doc.

    You have a lot going in the the lumbro-sacral area and it is difficult to separate out what might be the source of pain. On top of all the things you mention, another source of pain that feels similar to L5-S1 problems is pelvic floor dysfunction. This often can go along with loose SI joints. Since you went through childbirth fairly recently, it might be something to consider.

    It sounds like you have a nerve that is compressed, probably the S1 nerve if the standing MRI is any indication. Are you seeing a fellowship-trained spinal specialist at this point? It sounds like you have enough going on that you need to get a proper diagnosis and plan of treatment, either with an orthopedic spinal surgeon or a neurosurgeon who specializes in the neck and back...if you are not already doing this. If you are, I would suggest getting at least another opinion.

    Lower lumbar disc problems and stenosis can feel like the pain of hip bursitis. You can check on a dermatome map to see what spinal nerves refer pain to which areas of the body and limbs.

    Retrolisthesis can result in a stenotic situation where the spinal nerve gets compressed, and it can also close off the foramen, causing nerve compression. It could very well be the cause of your pain.

    I think a standing or positional MRI is useful but I also think that it does not show everything as clearly as might be seen in a high quality closed MRI. If your insurance would cover a closed MRI, I would suggest you have one.

    Since a discogram is very invasive and since the standing MRI did not indicate any amount of disc bulge, I would not have this test (at this point, anyway). While it is true that disc problems can show up on discogram that were not readily apparent on the MRI, there is usually some sign of disc deterioration or bulge that is evident on the MR images.

    Sorry my post is a bit disjointed. I hope you can make sense of it.

    I hope you can get some answers soon. Let us know what happens.

    xx Gwennie
  • pain and none of the open, closed Mri's or xrays showed the fact that I have annular tears at multiple levels. That is what causes some of my pain issues and that part of my spinal issues were diagnosed through a discogram. I do agree that all of the non invasive tests should be tried first but if they fail to provide answers it may take a discogram. You should speak to your doctor about this as he would really be the best one to say what types of testing may be needed in your particular case. Good luck and keep us posted.
  • I agree with Gwennie 100%. Ask for flexion/ extensions views.... I went through all kinds of torture before my flexion/extension xrays and discovered that I had pretty serious Retro.

    My fusion was the best thing that happened to me. It fixed the movement that was causing my discs to puch into my spinal cord every time I bent over.

    Now if I can just fix my neck.....
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