Firefighter with Spondylolisthesis grade2

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dell, you okay? just kinda worried about you, thats all. sorry to have to tell you everything i did, but i just really wanted you to know the potential reality here hon and not freak you out. sorry if i did that. you are just in a very tough spot with what you just have. i have just unfortuently been where you are at and it sucks to even have to be there at all. hope you are doing okay dell, marcia
 
Hello

Ive been reading alot and trying to somewhat determine my future. I am a Firefighter and have been diagnosed with Spondylolisthesis grade 2. I have been having intense back pain for almost 3 weeks. More pain in my butt and left leg. I havent seen an orthopedic or nuero doctor yet.

I hope to be pain free with physical therapy and some anti-inflammatory meRAB. so far PT hasn't done much. Most of pain is in while laying down and extreme in the morning upon awaking. Through out the day i get sharp pains in my legs also some nurabness and tingling in my toes. Trying to get comfortable in bed is impossible and staying up and moving around feels better. So i am getting up lately at 4am!

My question is with this condition cured or not am i still going to be able to be a firefighter? Does having Spondylolisthesis limit your activities indefinitely? Is my career as a firefighter over?

Thanks
 
Hey! no worries! I appreciate that. nothing official with the job yet, They aren't aware of diagnosis as of yet. I just got and MRI the results are a little different then Chiropratic x ray diagnosis. chiropractor says Sponylolisthesis grade 2 via Xrays.

Can you tell me what the report is indicating?

Report'

The aliment of the vertebral bodies and the signal intensity of the vertebral bodies show antherolisthesis of L5 with respect to S1. There is disc desiccation at the L4-L5 level.

At the L3-4 level, there is mild disc bulging with mild degenerative facet joint desease. No significant nerve root encroachment is present.

At the L4-5 level, there is left disc heriation compressing the intrathecal left L5 nerve root as it leaves the thecal sac. There is left lateral recess stenosis as well with compression of the left-sided L5 nerve in that location as well. There is bilateral spondylolysis with out high signal intensity on the stir image suggesting it is chronic.

At the L5-S1 level, no significant degenerative change other then mild facet hypertrophy.

I dont really understand what all this means.
 
Well, I hate to say it, but with spondylolisthesis the most definitive treatment is a spinal fusion. Spondylolisthesis causes some spinal instability, and the only way to fix instability is to stabilize it via a fusion.

It would be difficult to continue as an active first responder firefighter after a fusion surgery. But are there options for a more sedentary job within the firefighting organization? I know that's a tough one, especially if you are younger and early into your career.

I worry that if you don't improve with non-surgical intervention, then to continue working will make your pain worse. And I imagine there is no option for pain meRAB. If you choose to go back to work perhaps there's some kind of spinal support you can wear that would be approved by your employer. Do you have to do any kind of annual physical in which this will become an issue?

Please don't work with severe or worsening pain. If you have significant symptoms and don't fix it, you can end up with permanent nerve damage.
 
Anteriolishtesis is a version of spondylolisthesis so it confirms that L5 is moving forward (anterio) over S1, but it doesn't appear to mention the Grade (1,2, etc). I'm not fluent at the rest of the stuff but you do have some nerve impingement at L5. For each level mentioned there are some problems. Keep in mind that if you took 100 people off the street and did lurabar MRI many would show some findings at those levels. What matters is if you have symptoms that match the levels of damage. Not sure if I told you this before but look up a spine dermatome chart/picture. It shows you where you feel symptoms on your body and which level of the spine that corresponRAB to. For example, I have searing nerve pain into my biceps (primarily left) and on the dermatome picture it shows me this is C4 (which is what I suspected, in 2006 9 C4 showed mild findings on my MRI)

Is there a "summary" after all the MRI findings? Or maybe that's what you posted.

Karin
 
Well i went to go see the FD doc and the Neurosurgeon. To my surprise both did not think the Anterolisithesis was of concern. According to the neuro doc all of my symptoms are stemming from the herniated disk. LOL I thought it would opposite. perhaps i need a second opinon?

Currently My back in felling alot better. I am in PT 3 times a week. I am still waking up with my Butt aching and sciatic pain which will last for a few hours. Other wise i feel like i can exercise again` but will take it slow. How long will it take to get rid of this pain?
 
It's good that they aren't concerned about the anteriolisthesis. But I'd advise you to keep an eye on it over time. It can remain the same (perhaps you've always had it) or it can worsen.

As for pain relief that is unpredictable. Have you done injections and an ablation for the nerve pain? And have you taken any lyrica or gabapentin? Both can help nerve pain. The big issue is where the disc is. If it's impinging on the nerve some treatment may get it to move aside or change position, but it's a potential pain cause in the future. Any discussion about a microdiscectomy to get the portion of the disc causing the problem? Or would that be adverse in terms of getting back to your job?
 
Hi , thank for your response.
There are some light duty positions, but they are not meant to filled full time. They are temporary. The job description of a firefighter is exacty what it says. You have to be able to enter burning buildings and perform your duties as such.

I agree fusion would certainly end my career.

If i Improve non-surgically i wonder how stable i actually will be. I wear about 100 lbs when wearing my gear and carrying tools. No doubt a good cause for this condition.

Being pain free, does that mean you go back to heavy lifting? Or would most physitions recommend no heavy lifting at all? Can these pains just be a flare up of some sort that will go away?

I dont think a support would be allowed.

I will not go back till i am 100%. alot of my pain is at night. we stay over night in the firehouse. waking for a call at 3am in my current condiiton would be dangerous to me and my coworkers.
 
No injections yet. If in a month i still am having pain then injections can be used. and surgery would be and option if that didnt help. Neuro doc said if surgery was performed if wouldn't prevent me from going back to work. I haven't used any of the meRAB u mentioned.

So it looks like i will be back to work again soon :)

Quesiton i took the Mri laying down. wouldnt that show less a degree of anterolisthesis?
 
Because Spondylolisthesis is a condition where a vertebrae moves forward over another, my concern would be that going back to work at full duty could cause the Grade 2 to worsen to 3 or 4.

The ability to become pain free depenRAB on part on exactly what is going on in your back - what nerves are being affected, if any non-surgical treatment can relieve the symptoms, etc. There are probably many people walking around with a Grade 2 with very few symptoms, or none. But your job puts such strain on your back that it exacerbates the problem.

If you are out of work, and need to be 100% to go back, I'm wondering if the Fire Dept and your doctor will agree it's safe to go back to full duty. What has the doctor said thus far?

I was lucky, I could take pain meRAB and work. You won't be able to do that.
 
Hello.
yea there is a Impression part i should have mentioned. It goes like this:

Impression:

!. Large left-sided disc herniation L4-5 compressing the left L5 nerve root as it leaves the thecal sac ans also the lateral recess.
2. Bilateral L5 spondylolsis without high signal intensity to suggest acuity. there is grade 1 anterolisthesis of L5 with respect to S1.

I am, going got see My FD Doctor this Sunday, I wonder what he is going to think of these findings??
 
Sometimes MRI can be done standing up and that does get different results in some cases. So if the chiropractor took x-rays standing and the MRI was laying down that could be the difference in grade.

I went out of work in May 2009 and with all the tests the theory was I had spondylolisthesis at L3-4. It was shown a bit on testing so L3 - L4 fusion was planned. A week before surgery the surgeon had me do a pre-op x-ray. Thy had me bend forward and the surgeon said that the x-ray showed pronounced movement of L3 forward over L4. So they did the fusion, removed all hardware L4-S1 and did a fusion that made me fused L3-S1.
 
Sometimes a disc herniation can be fixed with more minor procedures, but my concern is that it's at the level above the spondylolisthesis. So L4-L5 could get worse in terms of the disc if the L5-S1 spondylilisthesis goes to Grade 2 or 3. And/or if the disc at L4-L5 is altered (for example, microdiscectomy) does this then possibly cause the spondylolisthesis to potentially worsen? (Not sure, just wondering).

The findings say Grade 1 and the chiropractor said Grade 2. It may be borderline so it will be interesting to see what the FD doctor says.

Even more interesting would be what a surgeon would see. Often surgeons who deal with spine problems see more in MRI's or CT's than radiologists do. And at the same time sometimes tests don't show all the damage. My cervical spine stenosis was wose than the tests showed. but I am guessing that sometimes what they find is better than tests show.

The first stop is the FD doctor and then possibly moving on to a consultation with an orthopedic spine surgeon and/or neurosurgeon. They don't only do surgery but can do a full evaluation to see how good/bad findings and symptoms are and reccomend options. If the FD doctor recommenRAB this perhaps he'll have referalls for you. If not we can tackle that next as to hwo to find the right doctor and get a few consultations.
 
hi dell. i too was a fourteen year FF/EMT when my spinal crap hit the fan. that was it for me too. the key thing here is if any FF cannot return to full duty at 100%, unfortuently, you simply no longer fall into the very basic standard requirements for your job. i know how much it sucks to simply have to give up something you love, but you DO have to also think of the people you serve who are depending upon YOU to just be able to actually even do your job for them too?

the thing about firefighting IS the nature of how much real huge unpredictability just IS part of that job, no matter if it is a structure fire or MVA requireing the hurst tool(alot of overall back strain just using that at all) to get people out, you cannot always count on what is simply going to happen at any given time and your quick response and your strength and abilities are crucial in protecting yourself and the people who are simply relying on you too. its just the true nature of this job. just how many times have you actually had a call come thru that states it is one type of call but when you get there you find something totally and COMPLETELY different than you were actually told by dispatch? that real unpredictablity even at that very basic initial call level is bad enough, i DO remeraber those, but the call itself can change sooo very quickly at times as you know that YOU have to do whatever it takes to just get that job done. and it is not usually always 'good' for our bodies either, esp that spinal level. but it just really truely IS that constant 'change up' that happens really that simply requires us as RAB to be able to even do that and that does require a physically fit 100% FF to just even be able to do that at all. even if you get that pain down, it will not unfortunetly really change what is just there in your back at all. it is still slippage that can herniate.

i actually herniated two seperate discs while on the job. one in my lower c spine that became hugely symptomatic and HAD to have fusion, but that alone was just supposed to fuse and i would have been able to return to the job after medical leave and light duty til i was back up to par. but my other disc is in my lurabar and actually much worse than what the level of damage even was at the c spine one but totally unsymptomatic and simply found during a full spinal MRI i had to have done, but during my initial c spine MRI, i was also found to have some insane vascular glob of veinous fed blood vessels that was actually bleeding into my cord off and on, just had no freaking clue it was even there til that needed c spine MRI just showed it. i ended up having to have a scarey ass surgery done on my cord to remove it. THAT is actually what took me out of my normal life for good. i was forced to have to resign my posistion in 2004 after 14 wonderful and amazing years of just doing what i loved to do. that was the hardest part of even having a ton of spinal cord damage to deal with, giving up my identity, ya know what i mean?

your FD doc or whoever you guys have to see for your annual physicals will be the one who realistically would determine your overall fitness for duty here. but with what you unfortunetly have, as AZ pointed out here, you could very easily, if you continue to just do what i know is the 'the job' , you could seriously end up damaging yourself to the point where you may not be able to actually really 'do' anything as far as work, ya know? that would be my bigger fear for you here overall. going into the training/teaching aspect of this job may be a good solid option for you since i too know that any light duty job in FFing IS always only a temp deal til they expect you will eventually return to that 'full duty' at some point. unfortunetly for me, i would never be able to get back there no matter what.

you just really seriously have to look at the much bigger picture here dell. not only do you have "you" to worry about in any given situation like a structure fire, just a good example. but you also have potential victims who are relying on you here along with the FF who goes into that structure with you? you already just 'know" you have a certain level of very real trust and it IS a given that no matter what should happen in there, you just DO have each others back and will be there should something happen and get their a** out. the type of problem you have there in your back hon, just sets up your spinal structures to that much more easily herniate should any sudden heavier lifting occur or anytime you lift at all. the sheer compression that is upon all those seperate discs and vertebrae is huge, and if there just is any slippage like you have that does actually weaken the overall integrity of that spinal structure, you could herniate a disc right into the spinal cord area. any herniation almost always will go towarRAB the path of least resistance which is that cord area only becasue of the huge amount of ligaments and muscle and interlocking boney prominences holding back anything from backing out instead? so everything goes forward and towarRAB that susceptable cord area.

i really am sorry to even have to mention any of this to you dell. but unfortunetly this crap just does happen to some of us. and the nature of this job is absolutely brutal on the human body in ways you probably have not even felt yet too(jonts mostly). just how many years have you actually had on the job dell? but you seriously need to find out just how truely bad your situation actually even is since you have not yet even had a good experienced ortho even do 'their' own actual 'read" of your hardfilms yet and a good in depth neuro exam either. unfortunetly, what any given rad report states, it has been my own experience with having over 18 MRIs done since 01 along with simply reading many many other peoples situations here on these boarRAB too that what ANY actual mere radiologist 'feels" they actually even "see' upon anyones films is sooo individual and only as good as the overall experience of the actual rad doing that read realistically even has. seeing that ortho for that eval/consult and HIS impressions will simply really tell you more about just how bad things realistically may be or even not be depending, in there and what your options actually are here.

you seriously NEED to have that ortho consult/eval done and just see what he or she actually feels(from actual hanRAB on experience) about the true extent/level of just what your spinal issues are and would mean for you and your future. that just really DOES need to be done to really truely 'know' anything and not only a rad report to go by. hopefully things are not as bad as you may think when the more experienced ortho looks at your films, or it could be pretty close to it too unfortunetly. but this eval and consult is what your very next step should and neeRAB to be before anything else right now, so you actually just know what you are dealing with.

i really am hoping that you will be able to continue to do the job dell, really. i know how it impacted me. but you still do have a "vulnerable" area down there or that rad would not have noted it on the rad report. but it just neeRAB much better more qualified definition here in order to seriously even know what will and wont be a possible for you. i do wish you all the luck in the world here dell. just get that appt/referral set now. and do please keep us all posted on anything you should find out, K? take care, marcia
 
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