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Grade II Spondylolisthesis & surgery

Gretchen1GGretchen1 Posts: 105
edited 06/11/2012 - 8:38 AM in Back Surgery and Neck Surgery
I was recently diagnosed with Grade II Spondylolisthesis, with a 35% slippage of L5 over S1 because of a pars defect. I just had my MRI this morning but know there is nerve compression from my symptoms and a previous compression of my ulnar nerve. I had been told for the past 2 years I had hip bursitis by two orthopedic doctors. It was the 3 orthopedic doctor, hip specialist, who found the true problem.

I have seen a neurosurgeon, specializing in spine surgery, who said I could try conservative treatment but he would not recommend it and surgery, fusion with hardware and possible decompression depending on MRI, would be the best treatment option for me at this point.

I also have an appointment this Friday at the Spine Center of an area hospital with an orthopedist.

I'm wondering if there is anyone on here from the Baltimore area who has had this same problem? I have checked out the doctors I am seeing but only know 1 person who has had back surgery to get a personal recommendation and that was for the neurosurgeon I saw.

I'm also wondering as far as getting second opinions, would anyone recommend getting two opinions from both neurosurgeons and orthopedists?

Any help would be appreciated. I'm so glad to have found this message board and have already gotten so much helpful information from reading everyone's experiences, both good and bad.


  • I'm afraid I can't be of much help because I'm not a medical professional, but I can tell you that if you have slippage and it is compressing the nerve, your first doc is right -- conservative treatment most likely won't help. You need stabilization to put things back as they should be and get the pressure off your nerve. Getting a second, third, and even fourth opinion can be a really good idea.

    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • 35% slippage is obviously not normal, but it does not necessarily require surgery either. I just had a grade I spondy and had no feelings of any instability, but I definitely had bad nerve compression. When I went for my first consultation, I had been assured I would be told about conservative measures. He looked at my MRI and then immediately ordered a flexion X-ray which clearly showed the slippage. At that point he informed me my only option was fusion. But, he said I didn't need to have it until I felt ready...that it was in no way a medical emergency.

    So I proceeded to see seven other spinal specialists, hoping someone would tell me there was a different procedure that would solve my leg pain...but there was no difference in their advice. So I waited as long as I could and when I knew it was time, I went ahead! Now I wish I hadn't waited so long as I just increased the number of years I was in pain and had activities severely restricted.

    There used to be quite a difference in training between neurosurgeons and orthopedic surgeons, but now they basically receive the same training. You want to look for a fellowship-trained spinal surgeon who devotes his practice to issues of the back and spine. (You do not want a neurosurgeon who prefers brain surgery, nor do you want a general orthopedic surgeon who does joint replacement etc....look for the Spinal fellowship in their educational background.)

    I would suggest getting at least three opinions...I think it is good to see both specialties as sometimes there is a difference in the way they approach problems. Then go with the one you feel most comfortable with -- who takes the time to answer your questions...where it doesn't feel like a "spine factory." I also like to feel comfortable with the office itself and the staff and nurses. I recently went to a new neuosurgery clinic for another opinion. When I walked in, the waiting room, which was large, was completely filled. As I sat looking around, I realized half the people had brought a long a lengthy book...so I figured this must be common to have to wait a long time. When I finally was taken back to an exam room after one hour in the lobby, the physician's ass't did the whole interview and the exam. The doc came in long enough to introduce himself...stayed a couple minutes, ordered some new tests and said we'd talk when I returned with the new test results. For a variety of reasons, I never went back. We all react differently according to our experiences and expectations. This is not the type of practice I felt comfortable in, regardless of this man's fabulous reputation!

    Luckily you have many wonderful options in the Baltimore area. The rules restrict us from mentioning specific names on the board. I am going to send you a PM about doctors.

    I would suggest you take your time in picking your surgeon. It is the most important decision you will be making regarding the future of your spine and subsequent issues.

  • Thank you for your suggestions. Have second opinion scheduled for tomorrow and third set up for later this month. Hopefully I'll have a connection with one of the doctors.
  • I had spinal fusion for spondy in Baltimore this summer. I would be happy to talk with you about my surgeon. He is awesome! PM me if you would like.
  • Let us know how you get on. I hope they manage to help you.

    I also have a grade 2 spondylolisthesis (L4/L5). Have seen a spinal surgeon who said he would do a laminectomy with fusion when I am ready. He did tell me that he thought it possible to get further pain relief if I did core stability exercises, especially pilates and using a fit ball. Needless to say, I am onto that. He said my disc at L4/L5 is almost completely gone with vertebrae bone on bone and will probably fuse themself. Has this happened to anyone?
  • I have heard of vertebrae fusing on their own, but it is more common in the cervical area. I think the real need for surgery comes when a nerve is being compressed. I guess I might be concerned that the bones might fuse together, but would they end up in the proper position or somehow out of alignment that might cause other issues?

    Many people have spondy and do not realize it until they have imaging for another purpose and it is discovered then. I was never aware of any instability with mine.

    If you can get enough relief through exercising and making your core stronger, more power to you!!

    Gretchen -- how was your appointment with the new doctor?

  • My initial thought was, great if they fuse themselves, I won't need surgery. Then I remembered that they were not lined up correctly and were compressing nerves.(I have bilateral sciatica.) I asked if they fused, it would make a future surgery more difficult. He said they could work with it, but didn't say exactly what.
    I think that my pain levels are lower than lots of people with spondylolisthesis. When my MRI results were given, they were surprised how I was managing to walk about so well. I have been trying all sorts of things over the last 11 months, to try to avoid surgery.
    I seem to be hijacking this thread, sorry Gretchen. How did your appointment go?
  • My appointment this morning went great, even though the orthopedist at the spine center agreed with the neurosurgeon that surgery would give me the best outcome because of the fracture and instability.

    The good news is both my husband and I loved the doctor and all of his staff that I saw this morning. He took all the time in the world to explain the surgery and the recovery. He was fine with the fact that I needed some time to prepare, financially mainly, since I work part-time. I went ahead and scheduled sugery for February 2nd. I will be having L5-S1 decompression, L5-S1 instrumentation and fusion. The doctor will also be using a protein to fuse the bones instead of having to harvest bone from my hip.

    In the meantime, to try to alleviate my pain, which seems to be all from nerve compression (have never felt back pain, only leg pain) I am scheduled for an epidural this Monday. I'm actually looking forward to this since I'm hopeful it will give me some relief until surgery so I can at least resume functioning.

    I thank everyone for their help and will be on the board regularly to get tips and suggestions on preparing for pre and post surgery.

  • Gretchen, so glad that your appointment went so well yesterday. Just hearing about your immenent surgery on 2 February, makes me feel nervous for you! I will follow your questions and answers you receive with great interest. I do hope that your epidural on Monday, gives you relief from the leg pain.

    I have been diagnosed a year ago with a 30% / Grade 2 spondylolisthesis on L4/L5. (Also pars defect) Although I do get back pain, my real problem is the sciatica in both legs. I now get lots of different sensations in my lower legs and feet (used to be just above the knee).

    I have just discovered this board and, like you am finding it really informative.

    I'll be thinking of you tomorrow for your epidural.
  • Chances are, it is the spondy that is causing the leg pain. Even though you may not perceive the instability to be a problem you notice, it is the positioning of that lumbar segment that is in all likelihood pinching the L5 or S1 nerve.

    I never had any back pain either. I think you'll find, jellyhall, that you will get more and more "new" symptoms of the nerve pain variety, as you wait to have surgery. I waited almost three years because compared to others' stories I didn't think my back was "that bad." Also, I kept hoping someone who invent a new technology that would let me avoid fusion. But when I got to the point where I couldn't stand for more than a minute or two, and I was driving down my driveway to get the mail out of my mailbox, I knew it was time that I had to do something. And, in hindsight, I probably waited too long and left the nerves compressed too long, even though every specialist I met with assured me I was not causing permanent nerve damage by waiting.

    Gretchen, I am delighted you found a spinal specialist that you liked and that spent time with you. The ESIs are worth trying, but don't be too disappointed if it provides only minimal distraction.

    Talk to you soon.

  • I waited a year before even going to an orthopedist and am sorry I did that. In Feb. 08 I was doing more activity then I normally do. My brother was diagnosed with laryngeal cancer and I was his primary transportation and caregiver 4 days a week. I just put the leg pain down to all the extra walking and stair climbing I was doing. It also wasn't an everyday thing.

    When I did finally go to an orthopedist, I was told I had hip bursitis. I even went to a second orthopdist, who happened to specialize in spines, because it was getting worse, not better. I've had bursitis in my shoulder before and it does eventually get better. The second orthopedist told me the same thing, hip busitis.

    I'm just sorry I waited so long before getting the correct diagnosis and not trusting my gut but the word of the previous ortho's I had seen. In the back of my mind I knew this was coming from a nerve as I had previously had cubital tunnel syndrome and surgery to move my ulnar nerve 12 years ago, when I was 30. My nerve damage at that point was that of an 80 year old and my hand surgeon couldn't guarantee I'd get anything back, just stop the progression of the damage. It took about six months but I couldn't tell I ever had a problem and it was my dominant arm/hand. I'm worried now that because I waited so long I may have caused myself permanent damage to my nerve and will never be free of the hip and leg pain, even with surgery.

    Jellyhall, my sciata pain started as just in the hip, buttock and upper thigh area as well and was intermittent. It soon progressed to the knee, then the calf, ankle, entire foot and now it's all the way to the tip of my toes, every single day. Most days I'm fine when I wake up but by noon, I'm finished and just want to crawl into bed. I feel lucky that it's only happening in my left leg. I cannot imagine having that pain in both legs. The doctor showed me on the model how, when I move, the bones just pound on that nerve, because of the instability from the pars defect. I knew then that unless I had surgery, this would be what my life would be like.

    Gwennie, I'm keeping my fingers crossed that I'm one of the lucky ones the ESI works for, even if temporarily. I did have a steriod shot in my hip back in April, when I was being treated for hip bursitis, and that did actually give me some relief for a month and a half. I don't know why I lucked out then but am going to be optimistic this will help.

    Luckily my husband and my family have been so helpful and understanding and I'm grateful for that!

    I'll let you know how the epi goes and thanks for all your help and encouragement.

  • Hope it all goes well for you tomorrow.
    Look forward to hearing how you get on.
  • How did you get on? Hopefully you got relief and are busy now enjoying yourself.
  • The procedure itself went went and was not what I was expecting. The doctor and nurses were great and it was over before I knew it, without much pain. I felt great leaving the place, until whatever they added to the shot wore off. I had about four days of horrible spasms and lower back pain. Once that stopped I have noticed the nerve pain in the hip and leg has lessened significantly.

    I'm pacing myself every day though because I do notice that by about 3:00 p.m. the tingling and pain begin. But, until I have my surgery that is going to happen because of where my spine is unstable.

    But I'm happy to have any relief at this point and the couple days of added pain were well worth it. I'm hoping this can hold me until surgery in February.

    Sorry to have not updated sooner. I wanted to wait a few days until the spasms stopped so I could have a better feel for how it was going to work.
  • It's great that you have got some relief from your symptoms. Did they give an indication of how long the pain relief might last?
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