Grade 2 Spondo- When do I need to consider surgery

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Wow SpineAZ, you're fast! That info about your neigrabroador makes me feel vinidicated and that I am indeed doing the right thing even though I'm not doubled over in pain. My surgeon had warned me to be on the alert for drop foot. There's probably been less than 10 instances in the past four years when I feel like I've "tripped" over my left foot. (All of my pain is on the left side.)

Related to that, I don't know what an EMG is that you referred to, but I did have a nerve conduction test and an ABI as part of a physcial for a new primary GP ten months ago, and the results indicated that I had moderate imingement on the right side, so I guess that's another indicator that I should be pursuing this sooner rather than later. (If I remeraber correctly, right side impingement causes symptoms on the left side, which is just what I have.)

Like you, I have right knee tracking issues as well totally unrelated to my back, but my handling of the issues affects my back! I had eight subluxations in a year (more painful than childbirth!), and worked very hard to strengthen my quaRAB rather than having surgery. I I'm happy to say that I've had no incidents in 2 1/2 years. Working on my quaRAB scares me a bit, though, as it relates to my back, but I tell myself that I'm strengthening my core at the same time. I use ankle weights to do some floor exercises (one on my hanRAB and knees where I lift my leg behind me, which I think is good for my back). I use 7 pounRAB on my right leg, but only five on my left since that's where my back always hurts, and I usually don't have much pain related to that exercise. I'm hoping that's not damaging my back more.

You "seniors" on this board are a wealth of information for us newbies! I welcome any other input!
 
I'm a new meraber and need some advice. I'm 52, and saw a surgeon 4 years ago after being diagnosed with Grade 2 spondolylosisthesis. I have a 40% slip with L4 slipped forward on L5. I also have an L5 vertebra which is sacralized. I was having some symptoms, mostly aching in one side of my lower back, and some nurabness and tingling in my legs. When he did a neurological exam, he found that I had trace reflexes in the knees and absent reflexes in the ankles. I could walk on my heels only with great difficulty and only if I leaned very far forward. (I had no idea that "normal" people can walk on their heels as easily as they can walk on their flat feet, and they certainly don't have to hunch forward to do it!)

At the time, the doctor thought I was an excellent candidate for surgery. He wanted to do an anterior discectomy at the L4-L5 level, replace it with bone, and use a small screw. He then wanted to use a posterior approach to perform a central laminectomy, and stabilize this with screws, roRAB, and bone from my pelvis. This all sounRAB terrifying to me. I told him at the time that I didn't want to pursue it. He cautioned me to watch and make sure that the weakness in my legs isn't becoming worse, especially difficulty walking on my heels. He said if it becomes worse it may be difficult to recover to a significant degree.

I went along my merry way for the next four years. I monitored my activities, and when I did have pain (I could go weeks at a time without) it wasn't daily and was easily knocked out by ibuprofin. Very recently I'm seeing a big increase in pain. I exercise daily, and after being diagnosed four years ago, ditched my elliptical and bought a recurabant bike, which my PT said was the best for my back. I never had any problem. Yesterday I noticed pain while I was riding but kept on going. Today I had to stop after 15 minutes because the pain was so bad. For the past week or so I'm finding that my pain is not only daily, but often during the day, and not as quickly alleviated with ibuprofin. I can't stand comfortably for more than a few minutes, and get the most relief if I lay down. (Sitting doesn't always work like it used to.) The pain isn't unbearably sharp, but it's that dull aching that many of you have probably experienced. Plus, I definitely feel more tingling down my left leg. I have a lot of difficulty walking on my heels, but can't tell if it's worse than it was four years ago.

Sorry this is so long, but I thought the details might help! I have a nuraber of questions and I'm hoping that some of you experts out there can answer!

1) Does anyone have any idea about the progression? How soon do I have to do something before it's too late? Do my new symptoms mean it's progressing quickly?
2) It sounRAB like an awful lot of surgery. Has anyone had a similar experience and had similar procedures done?
3) I've read all kinRAB of things about recovery time. I think my doctor had said that I might be able to return to work at least for a few hours a day within 3 weeks. Is that realistic?
4) I'm a big baby when it comes to pain, and reading these posts scares me. Is it really survivable?
5) I've heard so many instances of back surgery not working, but in a few cases I've read that this particular surgery has a higher success rate than surgery for slipped and bulging disks and similar problems. If you've had similar surgery, are you glad you did it? (I have to admit that reading the list of surgical risks really scares me as well.)

I really appreciate any input and support you can give. Everything I've read tells me that surgery is in my future. I always said I'd have to be crawling on my hanRAB and knees before I did it, but I imagine that if I feel constant pain like I do now I'd be more open to considering it since it's no fun to be in pain all the time. Then again, it sounRAB like a lot of you were in very severe pain before you did anything. Again, I guess I'm looking for some kind of a time frame.

Thanks in advance! I'm very grateful that I found this site!
 
Spondylolisthesis is one of the few diagnosis when you have a very reasonable chance of surgery working. Many failed back surgeries occur when the cause is more complex or harder to get to/alleviate. In many other types of surgery they are trying to relieve disc problems. Many of the pain and symptoms with spondylolisthesis are involved with the vertebrae slipping forward or back.

I had my first fusion for spondylolisthesis in my mid-20's. I'm one of those that will not deal with ongoing pain and am more fearful of permanent damage than I am of surgery. So as soon as my symptoms were nagging, painful, and not going away I went for surgery. I have very weak tendons and ligaments so this year L3 slipped forward and I had that added to the fusion.

If you are getting worse or symptoms are not going away don't wait. Pain may be something you fear but permanent nerve damage and/or weakness will be worse. Surgical pain is so much easier to deal with than permanent nerve damage pain. If you have not seen a doctor recently set up one or two consultations. Perhaps with an orthopedic spine surgeon (my personal favorite) and a neurosurgeon.

If it's Grade II (or worse) spondylolisthesis I would not let a surgeon do anything less than a fusion. Spondylolisthesis, by definition, is the slippage of a vertebrae backwarRAB or forwarRAB. Thus only a fusion will bring this back into proper alignment permanently. You want the fusion to be solid so that, as you age, you don't end up with further slippage The surgery you describe above, that had been suggested previously, seems to be going after the symptoms and not the cause.
 
Kelly12,

You are on the right track in doing all this research. The flexion xray will show if there is movement. No one can tell you when it is time. My doctor told me last year when it hurts enough to bother my life style and my work, I will be seeing him. Since I had fractures, I felt further slippage inevitable. You have to do what your gut feeling says. You may have no further changes the rest of your life. Or, may see increased issues soon or in a few years.

My post was edited, you can't list other forums, my bad. I was just suggesting to get all info possible from any sources you can. I even read medical reports from Universities etc. This is a good forum, my apologies to the MoRAB, I never read the fine print, even on purchases. :(

If you use the Quote reply choice, I think it will fall under the person you are replying to.

Yes, as mentioned, if you are having foot movement problems and nurabness along with a grade 2 slip, you may be ready. With a good Dr you will be fine. Recovery is months and the first few weeks are painful for most. But, like I said, if I didn't have severe nerve damage, I would be doing great. As is, I am still moving forward at 4 weeks post op.


Good Luck,


Ken




Ken
 
I had a grade 2 spondy at L4/L5. I did have the surgery. It helped, I'm not painfree, but much better than I was. The problem with spondy's is if they are unstable they can get worse. It can slip even further and damage nerves. In my case I was very unstable. The pain from the surgery is very survivable, discuss pain control with your Dr. before surgery. Just for informations sake, I tried PT and ESI's with no improvement, if anything they made it worse. My PT said with my condition surgery is really the only good option. In fact spondy is one of the few conditions that fusion is the recommended treatment for. As far as how long you have before you do permenant damage, everyone is different. You really should talk to your dr if your concerned it is worse. He is the only one that can tell you for sure. I didn't use bone from my pelvis. They used BMP and bone they took out of my spine.
 
Thanks Lilac, The one thing I didn't have was flexion x-rays; I'll request that this time around!
 
Thanks. That's helpful. I am going to make an appt. to see my surgeon, although it will probably unfortunately be a few month wait. What is BMP? (I'd love some option rather than him cutting into my pelvic bone-- might as well keep the pain localized in one area!) How far are you post-surgery? How long before you were able to go back to normal activities, i.e. work? Also, how did you know that your spondy was unstable? Did the doctor let you know that, or is it a given when your symptoms begin increasing?
 
Ken, you've been really helpful. (When I saw your response on my cell phone you had a link that I was anxious to view once I got to a computer, but it looks like it was edited out by the board moderators since I last looked! On this health board I think I've read virtually every related thread!) At any rate, I guess my one hesitation in pursing this is the fact that my pain is not overwhelming. It's increased in the last few weeks and sometimes I'm only really comfortable laying with a wedge under my knees, but it's still quite manageable; it's just that I'm aware of it a lot. Is that about where you were last year when you said if you had done it sooner your recovery would have been easier?

When I orginally saw the orthopedic surgeon four years ago, the orthopedist who referred me said he was one of the top two in the country. He is the orthopedic department chair at a major medical school in my area, and apparently does about 80+ fusions per year (with over 30 years of experience), so I'm feeling pretty comfortable about my physician choice.

Actually, I've been OK on the exercise bike since those first few days, but I do have pain daily and frequently throughout the day, even though I try to avoid ibuprofin unless it's really bad. Most people talk about pain having driven them to have the surgery. Do you know if the neurological symptoms are the ones that should be more concerning if the pain isn't as bad? (i.e. the lack of ankle reflexes and trace knee reflexes, periodic tingling and nurabness although not every single day?)

It sounRAB like you're doing well with your recovery and I wish you the best of luck! By the time my surgery becomes a reality (should I go through with it this time!), you'll probably be back to normal! I was encouraged when I spoke to a friend in her 40's yesterday who was in the military 20 years ago and fell 30 feet. She broke her back and legs, among other things. She was told that she would never walk again. She had fusion surgery then (It was upper back, and obviously technology would have been different), and she said that with all of her issues, two years later it was as if she had never had an injury; she was back to running up to ten miles per day. Now, 20 years later, she only feels it if it's an exceptionally rainy or cold day. (We're in Florida, so we don't get too many of them!) That made me feel like there really is hope! (You read so much about the necessity for subsequent surgeries as surrounding vertebrae take more stress from the fused areas.)

Again, thanks so much for your response, and I appreciate your taking the time to answer my questions and share your experiences. I'm sure I'll have more questions once I have my appointment, which is scheduled for July 9th.
 
Kelly:

My fusions were 17 years apart. I had no problems in those 17 years aside from the occasional back ache but that was easily taken care of by aspirin/aleve/advil. The primary reason L3 slipped forward is my anatomy - I have very loose ligaments and tendons so it was easy for L3 to slip forward.

An EMG is a test where they trace where the nerve impulses are, or are not, and can sometimes trace exactly where a problem may be. These are very common for neck and I'm not sure if they can even do a neck one.

However, if you look up a spinal dermatome chart it will show you each level of the spine and what areas of the body, and which nerves, may be involved. When I look at the spinal dermatomes I can pin point that my current cervical problems are C4 just by seeing where the expected nerve problems would be (based on where the C4 nerve and nerve impulses travel).

Originally my surgeon planned a 360 degree fusion but his new associate did a side version. So I have a scar along my back and then one, horizontal, just above my hip. I recommend you talk with the doctor and say "fix whatever it is you find" and if that requires a 360 degree fusion, though that can be a bit tougher recovery, it could be worth it. Just before I was rolled into the OR I had my husband and my surgeon there and I verbally said "do whatever you need to do when you get in there even if that means you have to do further incisions, more levels of fusion, etc, as I want this to be the last time I have to have the low back done".

I was lucky in that I have Short Term Disability (STD) and Long Term Disability (LTD) so I can take as much time as needed to fully recover.

Also, as for the notes, the way HealtrabroadoarRAB works is you see the responses in the order in which they occurred, there's no way to put it under the person who posted, it just falls in chronological order. So the best way is to address is to someone if you have a specific person you are aiming at (like you did when responding to my posts by starting with my name).

Karin
 
Hi Ken-

Karin below you said the responses fall in order, and you just need to direct the response to the person who wrote, so I'll try it your way and hers and see what happens! (By the way, my name is Nancy-- the "Kelly" is the screen name I chose in memory of my rottie/shepherd mix who I had to euthanize in Noveraber, so it makes me feel closer to her!)

It's hard to find too many people in the "real world" who have had this problem, so most of the advice I've been hearing, even from my GP, is that I'd be crazy to do anything unless I really have to. No one would look at me and think that I have any back issues. That's why I love this board so much-- the more I'm reading, especially in this thread, the more I'm becoming convinced that I really am progressing and really should do something. (Karin aka SpineAZ noted in an earlier post that her neigrabroador had absolutely no pain but just foot drop, and his wife convinced him to get it handled. He did have nerve damage.) She stressed that the neurological damage is more significant than pain. I guess you can over-research, but I obsess with things like this because if I'm going to do something so invasive with so many risks then I need to be sure that it's necessary. I've been doing a lot of research through google finding everything I can, and have read many of the university studies.

My hope is that if I see my doctor in July, I can do this by mid to late Septeraber (busy time at work prior to that but I think that timing will allow me to fast track and get done what I need to before being out for 6-8 weeks.) We have a cruise planned for the third week in January-- I'm hoping that that will allow me enough time to recuperate to having a good level of comfort. (Usually on a cruise I exercise every day to compensate for the eating. If not being able to exercise is the biggest price I pay I can handle it!) Think I'll be feeling good enough?

I'll keep you posted. Keep me update on how you're doing.
 
BMP is a synthetic bone that has a very high rate of success. Bone Morphenogenic Protein I think it stanRAB for. I was off work for 3 months but I have a very heavy job some people go back sooner if their job is more sedentary. I researched my surgery pretty well and didn't find anyone going back to work before 6 weeks. The doctor told me it was unstable, he took flexion x-rays and the bones changed position. Flexion is where you bend forward for one and backward for another. In my case my bones were moving about 7mm's so it was pretty unstable.
 
Actually, neurologic symptoms are more concerning than any back pain. If nerves in the spine are impinged it can result in permanent (or long standing) neurological deficits and/or pain.

My neigrabroador (early 60's) had no back pain. His right foot felt weak and had some tingling. It rapidly progressed to "foot drop". Luckily his wife is a medical assistant and knew that foot drop was a bad sign. My neigrabroador was hesitant to go see an orthopedic spine surgeon as he had no back pain. His wife dragged him to the doc to have a discussion about foot drop being caused by nerve problems in the back. So he finally relented and had a fusion in Deceraber 2009. He has had some improvement in the foot drop but slow, possibly due to how long the nerve was impinged before surgery. The good news is nerves can heal although it can be very slow.

I have a history of right knee problems including the knee cap not tracking well. My current knee pain worsened in part due to the lurabar nerve being impinged. Now I have to work on leg strength along with post-op core abdominal strength to get my abs supporting my body to aid in back stabilization.

Have you had an EMG? It can show nerve malfunction. I had one for my neck (they had to prove my arm/finger symptoms were due to cervical nerve problems and not due to carpal tunnel syndrome. I may do an EMG on my right leg.
 
Hi Karin-
To clear things up on the name, in case you didn't read my response to Ken, my real name is Nancy-- the Kelly screen name was my way of keeping my dog, who we euthanized in Noveraber, close!

Your response has been very helpful, and it's good to know that you've had minimal problems since the surgery 17 years ago. My fear factor is still very high, but everyone sharing their experiences is really helping.

I looked up the spinal dermatome chart, and it's right on target. (They have to make up names for the exact location of my problem, though, since I'm sacrilized at S5/L1. My aching is always on the lower left side of my buttock.

I'm not concerned about my time off too much in that between sick and vacation days I probably have something like 4 months available, and then my disability would kick in. However, I really don't want to be off for more than 6-8 weeks based upon what I need to do. If I don't wimp out, hoping for surgery early or mid-Septeraber and feeling good enough to go on a one week cruise in the third week of January. If I have 360 degree I'm still hoping to be back within 6-8 weeks-- hope it's not a long shot!

Nancy
 
Kelly12,

I was like you, L5-S1 partial sacralized, grade two slip and fractured pars allowing movement of the slip as shown in Flexion Xrays. It will get worse. You should get 3 surgeons opinions on exactly what they would do. MRI should show what nerves are pinched and how bad. My nerve between L5-S1 was smashed badly.

My surgery was to cut apart L5-S1 so they could be decompressed then spacers put in, then however they do the fusion material. Some bones were cut away and nerve now has room, but is going to be a slow heal. Some of my pre-op pain is gone, like severe right groin pain. Right leg now is pain free. The left leg has some nurabness and sciatic pain from the nerve now being free and kinda mad. The left side was the worse, but both legs were weak and had sciatica pre-op.

The first 3 weeks post-op lots of pain, can't sit, stand, walk for long. Worse at night. I am 4 weeks post op and can walk a lot with no cane let alone no more walker. Left leg is going to be a problem for awhile, maybe 6 months or longer. But, had I not waited a year it may not be as bad as it is. Now on 1 percocet every 6 hours and 3 nuerontin a day. I plan on being back to work in 3-4 weeks from now. Not a physical job. I walk as much as I can and start PT next week. I think I can sense small improvements in nerve healing, so I don't think it will be a serious issue permanently. I won't be 100% physically or pain wise. But if I can get to a couple Tylenol a couple days a week, I will be very happy.

Have them show you the pinched nerves on the MRI/CT's. You need to be 100% sure that is the only cause of pain and again get several opinions and research your doc anyway possible. Talk to everyone about your condition and ask for good docs if they had similar issues. I had a good one fortunately.

I am 59 and like you would not have helped myself by waiting. You are already getting worse and as long as you find a good doc and have the exact cause of pain identified, I would not wait. One lady did on one of these boarRAB and is now in a wheelchair. Everyone is different, but the first 3 weeks were painful, especially over nite and getting up during the nite and in the morning. But it did improve a lot the last week. As far as my left leg which is still fairly painful, time will tell. But, I would do it again. Waiting can be devastating.

These are my personal opinions and I can't diagnose you. But, you sound like me and lilac100. < edited > The more you research the better.

Final opinion is with increasing pain and nurabness, I wouldn't wait. It shouldn't take several months to see a doc. Although, I don't know where you live or you heath care provider policies.


Best of Luck,

Ken
 
Hello SpineAZ- Thanks so much for your response. (I'm still struggling with how to get responses to fall under the person who was nice enough to take the time to write-- it appears they're all going to the bottom of the thread!) I think I may be where you were; symptoms nagging, but not unbearable. That's why I feel like a bit of a hypochondriac pursuing this again. (In my response to Rugmankc I describe it a little more specifically!) I don't like the pain but can live with it; I'm more scared of irreparable damage due to the neurological symptoms if I don't do something soon, which is why I'm getting it rechecked.

As of four years ago my spondo was a Grade II (40%), and my doctor wants to do fusion; he never suggested just doing a repair. (I think he had alluded to the fact that he didn't anticipate increased slippage, but I didn't have flexion x-rays done, so I'm not sure I understand that. Maybe because my spondo is isthemic rather than degernerative?) Anyway, I need to get more clarification about the anterior discectomy he wants to do. From what I've been reading on these boarRAB I think that when they do both front and back it's considered 360 degree surgery (longer recovery), and I'd prefer his just going through the back if possible.

I already have about 15 questions written down to ask him; no telling how long my list will be by the time I have my appointment in two months!

Did you heal well from both surgeries? How far between the first and the second surgery? (That's what scares me; it seems like so many people have to go back for a second fusion.) I'm in excellent health and do both cardio and strength training regularly, so I think my core is in good shape, but I'm far from being in my 20's and don't want to deal with this again in my 60's.

Again, thanks for your time. I look forward to reading more posts! This health board is such an awesome resource, and there's no better place to find people who can emphathize and give some good advice based upon experience rather than just saying they'd never do back surgery under any circumstances.

If anyone else has any pearls of wisdom I'd love to hear from you!
 
Nancy,

Recovery time is different for everyone. My sister-in-law went to Disney World from PA at 4 mos and survived. Had discomfort, but you walk a lot there. On the Cruise Ship you can control your activity. Like me your recovery will depend on the severity of the nerve damage and it's healing time. Four mos is enough to recover from the surgical site issues. But nerves can take months to years. My recovery time is still up in the air. Gut feeling is 3-6mos with lifetime of some pain and discomfort, hopefully minimal. Again, don't under estimate the first 3 weeks post-op. They were real tough. But, more than worth it with my recovery to date. I would guess a 70% chance you will be good to go. No promises :)

A far as the Quote Reply and the order, it is different on different forums. Not sure how it works here yet.




Ken
 
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