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Spondylolisthesis...realistically will PT help avoid surgery or just put off the inevitable? Update

Penguinz90PPenguinz90 Posts: 22
edited 10/10/2014 - 9:24 AM in Back Surgery and Neck Surgery
I am a 46 yr old female who slipped on 2 steps 3 months ago, and to stop myself from falling more I grabbed the rail, and my lower back really wrenched itself. I was stiff and sore but figured some Motrin and time and I would be ok. Six weeks later I was at urgent care because the sciatica pain was so bad. X-Rays showed severe arthritis in my lower back (from car accident 24 years ago) and slipped disc. I saw a pain managment doctor who ordered an MRI which showed 2 slipped discs (L3 and L4). He said L3 appears to have been slipped for many years and there's a lot of degenerative issues there. 3 epidural/steroid shots and another 6 weeks later and I am no better.

I saw a neurosurgeon this week who confirmed the slipped discs, severe arthritis and he ordered 2 more X-Rays, one while I was bending forward and one while I was bending backwards. Before he said anything even I could see that in both shots one disc keeps going in the opposite direction of all of the other discs.

The doctor is pretty conservative and wants me to try 6 weeks of physical therapy, if that doesn't work the next step is spinal fusion with these horrid looking metal rods to go on either side of the discs. He is conservative, but in his voice I swear he wasn't sounding too convinced that the physical therapy was going to do much for me, but he wants to try something before jumping right to the fusion.

I'm a pretty physical person (I've run 4 marathons, although I am out of shape now because I'm too scared to be on my feet for too long now because it hurts too badly by the end of the day if I am) and I need to carry heavy trunks for my job (30 lbs or so) which I am doing, but not happily right now. The sciatica is annoying and sore, and I've been told many times that I must have a high tolerance of pain...so I just deal with it (I take one Percocet and Lorzone at night, otherwise one Naprosyn during the day), but what bothers me the most is the shaky feeling while standing, like it wouldn't take much to tap my legs in the right spot to make me fall down, I hate it!

So realistically what are the odds of physical therapy helping something like this? I need to mentally gear up to this if there is a high chance of needing surgery. What is recovery like from something like that? What are the odds I could ever run again? Any information or thoughts would greatly be appreciated. Sorry this is so long.


  • Smiles1SSmiles1 Posts: 22
    edited 10/01/2014 - 5:02 AM
    Usually your insurance company wants you to exhaust all non-opertive options before they will pay for surgery. So its not necessarily your doctor, but the insurance that dictates what services he can provide you. You have to go through all the motions before your insurance company is convinced that surgery is the only option and will approve & pay for it. And as for physical therapy some people benefit from it and some don't. One benefit is they can inform you of what exercises you should do so that you can build strength and core support if you happen to need surgery
  • kinpainkkinpain Posts: 958
    edited 10/01/2014 - 12:07 PM
    One of the major reasons for spinal surgery. Like Smiles1 said, Your NS has to salsify the insurer that conservative methods like PT didn't resolve your issues. Hopefully, once your spine is stabilized your sciatica will disappear, at least this is what happened with me. Wishing you relief from your pain!
  • Well, it helped me to postpone it for awhile. This in conjunction with Chiropractic visits, decompression machine and disc pump. My first MRI, showing an issue, was taken back in 2002. Subsequent MRI's showed progressive degeneration over the years however, the last ones,2009,2012 & 2014 were basically the same. I will add that I'm a 52 Y/O in shape male, HWP,dedicated to the gym 24+ years, runner and non smoker. I believe these attributes contributed to me postponing surgery for this duration.
    I would try every non evasive technique within reason prior to surgery. Then, only after all avenues have been exhausted would I consider surgery. At that juncture, research and seek out the best provider in your area. Also, ask a lot of questions during your appointments. It really helps to write them down before hand. Take a tour of the hospital, OR & where you'll be during your stay. This helped me to alleviate some of my apprehension.
    As for myself, 7 weeks post op, I'm doing pretty good. The pain is still present but continues to dissipate weekly. I've been walking about 2 miles a day for the past 5 weeks. Prior to that, about a mile per day. Also, went back to the gym yesterday. No weights yet just treadmill and elypitacal. Light on both, but at least It's a start.
    I hope this information was helpful!
    Good luck and God bless!
    Bilateral L5 spondylolysis L5 with grade I anterolisthesis L5-S1.
    Stable multilevel degenerative spondylosis contributing to mild canal
    narrowing L2-3 and L3-4.
    360 ALIF & PLIF L-4 - S-1 on 8/11/14
  • Thanks for the responses. My insurance doesn't require PT prior to surgery, but the neurosurgeon likes to be more conservative, but honestly he didn't sound convinced it would help. It also sounds like because of the severe arthritis and degenerative state of my disc surgery will be more intensive (apparently the amount of degeneration is what they would expect with someone in their 70's, not 40's). I used to be active, but now if I stand for an hour I am absolutely miserable. I feel incredibly shaky, and my sciatica burns horribly. The only thing that gives it relief is a Percocet followed by completely getting off of my feet (which I will only take one at night, I work with kids and can't be foggy brained at all, instead I'm just miserable). I've had 3 steroid/epidural shots and the last 2 have made things feel worse, and unfortunatly my insurance won't cover chiropractic care at all. I was somewhat active this weekend for my son's birthday and am completely in spasms over it now. I went to my first PT appointment and he said I couldn't lift anything more than 5 pounds (he was very clear about this) because it's so bad, no bending forward to grab things and he gave me a bunch of exercises to try to strengthen my core, which I am doing. I am starting to get depressed because I am usually a very physical/active person and hate to have my body betray me like this. I just need to do whatever it takes to get this better. I want to be active again, maybe run again (although I'm not holding my breath on that one, I think there are no more marathons in my future), I want to be able to walk through the grocery store without having to lean into the shopping cart to get around. :(
  • Penz, if you feel your quality of life is being affected that much, and you want to have surgery, you don't have to complete all of your p.t. Have you scheduled your next appointment with you neuro? If not you may want to get on that so you can schedule surgery sooner. I know it took me almost a month an half after I told my doc yes to surgery to get scheduled for it. Plus we are going into the winter months and that will make things harder. I'm glad I had my surgery in august because I don't know how I would be able to hand doing this through the winter months. Just some thing to think about. Hope you get some relief, and good luck.
  • Thanks Smiles1. My PT and I decided to give it a solid 2-3 weeks and go from there. My next appointment is scheduled for around 5 weeks with the neuro. My dilema with surgery is that I do science stage shows for kids and don't know what to expect for recovery. My shows are an hour long with me on my feet, moving around quite a bit. If I am not doing heavy lifting how soon could I be back to doing that? I only have 1-2 scheduled per week, but have them scheduled throughout the year. I can't reschedule them and don't have more than maybe 1-2 weeks here and there without a show scheduled. I wonder how soon they would let me go back to doing that. I tend to tolerate pain pretty well, I was on stage doing a show the day after I was released from the hospital after having my gallbladder removed because the person who was going to do it had a migraine and couldn't do it. I just had my husband grab everything, set it up and I did the show, no problem. I went home and crashed after it was done, but I worked through the discomfort. Again, not going crazy, but if can do 1-2 shows a week or two after surgery that would be awesome. If I have to go 4+ weeks I am screwed.
  • It is pretty unlikely that you will be doing any shows for at least a few weeks......depending on the type of surgery involved, the extensiveness of it, will determine how long you are unable to do those things.
    Going through spine surgery is NOT like any other surgery out there, and the restrictions and limitations are there for a reason. You can UNDO all of the benefit of the surgery by doing more or pushing through the recovery of surgery and the restrictions . They are there to allow your body time and space to heal, and you endanger your outcome by doing more than you are supposed to, by trying.

    I would strongly encourage you to talk to your surgeon about the surgery, the recovery phases, the limitations and expectations before going ahead with surgery......
    Fusion surgery is a long, protracted recovery, and it can take several months before your body is ready to resume some of your activity post op......the fusion itself can take up to a year before a solid fusion is developed, so you need to prepare yourself for this surgery.

  • Smiles1SSmiles1 Posts: 22
    edited 10/04/2014 - 6:02 PM
    Like Sandi said it will take a lot out of you. I was exercising 5 to 6 days a week, was fit, healthy and I was drained of energy for weeks after surgery. I only had one level done and I will most likely get release back to work just under the 3 month mark. Also you can not lift anything over 5lb for at least six weeks if not more. Depending on which surgery they do you may have larger incision areas or muscle that they cut through that will take longer to heal. Having a strong pain tolerance is good but be aware you will have pain that maybe tough at times. This surgery is no cake walk and you will need the time off to recover.
  • Thanks for all of your insight, I do appreciate it. My PT swears I can avoid surgery by being diligent about the exercises and strengthening my core, but in the one week of doing it I am feeling far worse. I woke up today in pain and standing is horrible...I usually only feel that by the end of a long day on my feet, so I'm not sure what is going on. I have lots of pressure in my lower/mid back and I can actually feel the disc moving around when I turn here and there. I don't know if this is a matter of things getting worse before they get better and I need to give it more time or what. I don't want to be an alarmist and jump right into surgery because I didn't give PT the chance it needed. Then again if in the long run I really am just going to need to have this done I want to know that too.
  • I'm so sorry you're going through all this. I'm in the same boat except it sounds like your issues are a little worse than mine. I'm trying to decide if a fusion is the way I want to go. I have DDD and spondyolisthesis at L4/L5 with horrible nerve pain down my legs and muscle spasms. I can also feel things moving around and popping in my lower back. I'm miserable by the end of the day. I've been having problems for almost 2 years. I also had epidural injections which didn't help. I just finished 4 weeks of physical therapy (my second round) and it didn't help at all. Are you doing traction in PT? They tried it on me and it caused my lower back muscles to spasm so bad I could hardly stand up. I liked all the stretching though and still do it. I hope you have a better experience with PT than I did! My doc told me to call him when I'm ready for surgery but to put it off as long as I could. I have 3 small kids and I feel like I'm missing out on a lot of things with them. One day my mind will be made up to do the surgery and the next I've changed my mind. I still have some good days and on those days I feel like surgery would be a mistake so I'm still undecided. Anyway, sorry for the book! I just wanted to let you know I understand where you're coming from. I'll be thinking about you!
    37 years old
    DDD at L4/L5/S1
    Lamenectomy to remove synovial cyst March 2013
    TLIF at L4/L5 March 10, 2015
  • Well I saw the neurosurgeon today and he wasn't surprised at all when I said PT wasn't working, in fact I was feeling worse. I asked him point blank if PT could potentially help long term or if I was going to need surgery down the road. WIthouth skipping a beat he said I would definitely need surgery at some point to fix it. He said I have a significant slippage of my verterbra (50%) and that PT and the injections were to potentially give me some relief (they did not) but surgery, in his opinion, is unavoidable. So we set a date of December 2nd. He said he will need to take some bone from somewhere else to help build up the verterbra, do a lamenectomy on my 2 slipped discs and try to line up the verterbra as much as possible, but with that much slippage he didn't think he'd get it fully lined up, not without risking nerve damage...so taking care of the nerves will be top priority with ligning things up second. I'll then have a cage placed in the front with bolts to help fuse everything all together.

    He's let me know it's a big deal, but he agrees that if I can't even walk around the store with my kids and am going straight to bed when I get home now and am not getting any sort of relief with the PT and injections that there is no sense in waiting any longer, and I agree with him. The only reason why we are waiting until December is that December and January are my slow times at work and I will be able to take time off then. I am going to continue the PT since it can't hurt going into surgery with as strong a core as possible.

    So.....any words of wisdom from here on out?

    Teresa, thanks for the kind words. Sorry you are having such a hard time, my kids are older which makes it easier, I can't imagine going through this with little ones. No, we haven't tried traction, but with surgery now a for sure I doubt we will try much else at this point. Good luck, I hope you get some relief soon.
  • He didn't say 360, but said he prefered putting it on the front because of type of slippage and he felt it would be more stable there. Does that make sense? Maybe I misunderstood, but he definitely said he would be putting the cage on the front. Thanks for the links above, I have been doing a lot of reading on this site (and others). I know everyone's experience is different, I just figured the more I heard about others experiences the more it would help too.
  • I assumed he meant a 360 due to the mention of the laminectomy as well. The lamina is located at the back of the spine.
    They can insert the cage and hardware from the front to do the fusion.
    I wish you a successful outcome.......
  • So would that mean incisions in the front and the back as well to do that? I know I will have a pre-op visit to go over things in more detail. Thanks for all of your help and information, I really appreciate it.
  • but he may be able to do the laminectomy from the side, rather than the middle of the back or minimally invasive. It's hard to tell what he is planning from what he has said so far.
    You are quite welcome......I'm glad that I could help.
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