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Mild Stenosis w Spondylolysis

cactusredccactusred Posts: 46
edited 06/11/2012 - 8:57 AM in Spinal Stenosis
Hi all, first post here, and have done some reading, and frankly got myself worked up a bit at all the horror with folks on back pain, stenosis and surgery's etc.

I'll begin my story about 15 years ago, started noticing my left leg kind of numb and tingly. I went to a chiro, he took some exrays and said I had some birth defects and some areas that were were trying or were fusing. He recommended several treatments to get my spine mobilized. After a few weeks the numbness did go away.

Over the years since, once in a while I get a little inflammation around my I would say left SI joint but with stretches it seems to quiet down. About 4 weeks ago, the irritation just seemed like it wasn't going away, in fact I was having some problems trying to get comfortable sleeping, just tossing and turning. So I went to my doctor the next day.

She gave me some mobic 15mg and muscle relaxers at night did an mri and I asked for physical therapy.

I'm in pretty decent shape as it is, not overweight.

The MRI says the following....

L1-2 through L4-5 No abnormalties.

L5-S1 There are bilateral pars defects at L5, without spondylolisthesis.Mild assymmetric left disc bulge and left facet hypertrophy result in mild left foraminal stenosis. The spinal can is patent.

Note is made of a hemangloma of the L5 vertebral body.

So what I understand of this is I think have a birth defect this pars defect deal. And some DDD that is happening at L5 and s1.
I'm just wondering what my chances of avoiding a surgery and quality of life are with this? I am working on core excercises in PT, which I'm finding crunches weren't working my correct abd like I thought. My chirco says this would be a little cleanup of bone if it's pinching the nerve. I just don't know what to think, sure appreciate the feedback and info.

I'm 40, and lead a pretty active life and don't mind changing some things up but I sure hate the thought of my quality of life tanking right now.


  • Hi Farmboy,
    The "pars" is the bony bit on each side of the bone that you can feel at the back of your spine, on each side of that row of bones that you can reach back and touch. It seems that yours has a break in it, on each side. This is a common injury. As to whether or not it is healed or not, I can't tell from your report.
    Degenerative Disc Disease is a misnomer. It is not really a disease, it is simply a drying out of the discs that happens to all of us as we get older. In fact, the majority of people will have it if they are older than 21 to some degree or another. In most people it is not painful, but in some cases, especially severe drying out of the discs that cause deflation or compression of one vertebre on top of another, it can be.
    Facet hypertrophy is a thickening of the facet joint. The facet joint is at the back of the vertebreal canal, where the vertebre meet. It is a tiny joint on both sides of the canal. This can happen because of wear and tear on the facets, and also can be caused by a decreased disc space ( ddd)in moderate to severe cases. Yours is only on the left side, where you also have a assymetric disc buldge, which means that the disc is not symetric and is a bit misshapened on one side ( left ).
    A hemangloma is a collection of blood vessels in the vertebreal body.
    Forminal stenosis is mild, but the foramen is where the nerve roots exit the spinal cord/canal and descends to the part of the body it is responsible for providing sensation or motor control to. You have two exiting nerve roots at each vertebra. L5-S1 is one level, L4-L5 is another, L3-L4 is another, etc. Mild stenosis means that there is some small amount of bony overgrowth in the canal where the nerve root exits between L5-S1.
    If the compression is bad enough that it is causing nerve compromise the surgeon may suggest a laminectomy or laminotomy to clean up that tiny canal so that the nerve isn't compressed anymore and hopefully that would relieve your symptoms and get you back to your active lifestyle.
    Hope all of this helps to explain things a little, or did I make it clear as mud now? LOL
    Anyway, good luck and ask as many questions as you need to.......
  • Sandi, thank you for the detailed explanation, that is very helpful. My doctor tried to explain some of it and my chiropractor tried to explain some as well.
    I'm wondering if on either side of my I guess l5 s1 area, (close to the spine near the SI joint area feels like a knot the size of olive. My chiropractor said it was lipoma I believe, or fat tumors, maybe thats the area or the same type things as the hemangloma?
    As to the mild bulging to the left, any ideas as to why someone would have to one side or the other? Like carrying more weight to one side or walking incorrectly, or something. I am right handed, I don't know, I'm just grasping at straws at what I could do to be proactive and possible avoid more damage or a surgery.

    Thanks again for looking.
  • Wow great job Sandi, Very nicely explained,

    Cactusred: As sandi said the ddd is not always a big deal , Many people find out they have ddd and freak out when most people have that and never need surgery or never even have any pain from it,

    But it does sound like you have further issues other then just ddd so you will have to realy go over it with your dr to see what the best treatment is in your own case,

    Bulging of the disc is as most only have the disc bulging to 1 side where it give out and if worse comes to worse then they do a micro d. Surgery to remove that part of the disc if its severe, If the dr dont think its severe enough to do surgery then you can try to do like pool thearapy and such to remove pressure off the disc and in some cases it can correct itself on its own,

    Get more then just 1 opinion from dr,s and do everything you can in alternative treatment before doing surgery, As most dr,s will or should tell you that anyways if surgery is not realy needed,

    Good luck and let us know how things turn out,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Hi CactusRed,
    Yes, a lipoma is a fatty tumor for lack of a better description. I have a large one from L3-S2 so you aren't alone in having one.
    As to why a disc may bulge on one side and not another, it can be a weakness in that particular area and then you lift something one day and the disc is further weakened and it becomes a bulge. It's not really a problem for most disc bulges unless it bulges enough and in an area where it comes into contact with a nerve root.
    Physical therapy, stretching , and aqua therapy all might help you avoid surgery. Injections might help to soothe any inflammation in there as well. Sometimes we can simply move the wrong way one day and it will make our backs simply scream at us.....when all of the thousands of other times, it doesn't bother us at all.
    I would consult with a surgeon , board certified spinal neuro or ortho surgeon , and a physiatrist, who can oversee your care, and send you for the proper back strengthening and any further tests or imaging you may need to make sure that you are in the best shape you can be.
    No one wants surgery, and it may not be something that is warranted but you want to make sure of that and see what other treatment options are available for you.
    Good luck,
  • Appreciate the replies back. I have taken the last couple of weeks off work to give it a bit of a rest and discussed light duty in a few weeks if things will progress for me, hopeful I am. I have just finished my second week of PT, am doing it the same place I did my shoulder labral repair, they did a pretty good job, and seem pretty conservative.

    I am currently on mobic 15mg for some inflammation, and am icing a few times a day, though I don't know if that would really reach the disc/spine area. Plus muscle relaxers at night when I sleep. I go see the doctor on monday and it seems a touch less aggrivated, (knock on wood), but I'm going to ask for a recommendation to a neurosurgeon and or a orthopedist. I would like to at least consult with one and get all educated info in front of me.

    I'll be the first one to say, I would not want to undergo surgery nor would I want to see a specialtist that immediately said, lets get you into surgery without exhausting any, all, conservative methods, alternative or not even.

  • Cactus,
    I think that seeing an ortho or neuro spine surgeon is a good idea. That gives you a good read on exactly how things are and if there are concerns or restrictions you may need to follow for a bit.
    If you do come across a surgeon who tells you that you need surgery right away, or even see one who recommends surgery later, make sure to seek out at the very least two other opinions. That way, whatever decision you may have to make is the right one for you.
    I'm glad that it seems like things are slowly improving. Let's hope that things stay on that tract for you and you have no further need of surgeons down the road.
    Good luck
  • Well, saw a neurosurgeon last Thursday. Very nice guy, my appointment was about two hours late, however I read online that was one complaint folks had that wait times were real long. I can understand why, he spent a good hour with me, and he explained that he was more concerned with patients care and understanding of their problems, even if it meant he was running behind schedule.

    Anyway, he looked at my two mri's from 2008 and the september 2011 ones, and said they were exactly the same, he was impressed that there wasn't any more degeneration in those three years.

    He discussed the benign tumor and said in about 1% of patients, it's very aggressive and can cause complications, and that was one of the main reasons he wanted to look at 2008 mri. He said it hadn't changed at all, so that wasn't an obstacle.

    He reviewed my history, and said the pars defect had been there for many years, and he said it was up to me whether I would need surgery or not. He said my discs still look pretty good, and at my age of 40 he wouldn't consider me as a surgery candidate. He did say if I continue to abuse my spine, improper lifting, turning, and axially loading it up with some excercises at the gym, that "we will dance" is how he put it.

    He did give me two injections, he referred to them as trigger point injections in the low back, not the epidural type injections. Also gave me a prescription for this fancey brace I'm wearing right now. Told me he wanted me in this thing for 6-8 weeks, except when I sleep.

    Continue to take the mobic and he felt there was no reason I shouldn't return to normal day to day activity's. I hope he's right. If I was to have to have a surgery, I wouldn't even want to consider it for several years.

  • That sounds really good Cactus! I am glad to hear that things haven't changed much at all since 2008, which is excellent news for you. It means that you haven't done too much damage in the meantime
    Honestly, hearing that you don't need surgery is great news and if wearing the brace for a bit will keep you from having to see the surgeon to schedule surgery, that's great news too.
    I'm glad that things went so well and you know what, having a surgeon who takes the time to explain things to patients is one that you want to keep.. Too many of them don't take the time to explain things properly to patients and so you will want to keep his name and number, just in case you need him somewhere down the road.
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