My Nuero Follow-Up- Good News, I Think?

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cherylww

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Hi Everyone! I hope you're all feeling good today!

Well, my visit seemed to have gone well with good news. I mean, about as good as it can get when you're in pain, I guess. The doctor told me not to worry about the bulging disc. He said that most people have those. He said the 2 dried up discs are a normal aging process and there's nothing I can do about that. He said that the only thing that he suspects is the problem is the spondylolithesis in the L5-S1. According to my history, he believes that it's been there for a long time, but he says the same thing that the ER doctor said, that I pulled my back out and irritated the tissue around the spondy. Huh? Could it be that simple?

So, he is sending me to PT, and says that he thinks I'll heal up on my own. (Even though it's been 9 weeks of pain?) He said that surgery would be a last resort (which I knew), and that the outcome from surgery probably wouldn't be good. So, I guess he's saying that surgery would mess me up, when I would probably heal up on my own anyway.

I asked him about PT, wondering if they would help me align my misalignment (right hip is up higher than left) and he laughed at me saying that we can't change my structure. I told him that I've read that when you get your muscles evenly distributed, that it can pull your spine back into shape. He said that it could be possible.

I think I feel good about this. At least I got him to say that it really isn't very bad over and over again. It sure feels bad a lot of the times!

Anybody wanna comment? I mean, I know that the doctor can't tell me what my future holRAB, so I guess I'm just going to move on to the next step and hope that this blasted sciatic pain goes away. I can deal with the normal back pain, but the sciatic thing is driving me bonkers!

Thanks for reading my novel here! LOL!

Cheryl
 
I agree with MarloM on this one. You may have been Grade II for a long time, but with spondy.. .your spine is still unstable and must be watched closely for any changes that may occur.

You may also benefit from some injections of the facets.

Did he even offer to put you into pain management to try and make you more comfortable along with your PT. PT is only going to be a successful as your body is willing and if you are in great pain, it's going to lessen any effects of PT as you can't do things when you are in constant pain.

I would also suggest a second opinion from an orthopaedic spine surgeon, especially since you have no nerve issues evident at this time and it's more about the structure of your spine that is of the utmost concern.

I wish you wellness.
 
Sorry I've taken so long at replying here!

Yes, I did a lot of gymnastics as a kid. I would say from age 12 to age 16. I did a lot of high dismounts landing from the uneven parrallel bars. I also did a lot of flip flops and floor routine. Never had any back trouble until after I had kiRAB 21 years ago.

I think I ould like to see an ortho doctor just so I can at least get an opinion. I'm still wondering why my x-rays showed a grade I (25%) spondy and my MRI showed a grade II. It looks very scary, but I'm trying not to let it get to me.

Thanks for the help! :)

Cheryl
 
This was my MRI print up from a couple of weeks ago:

IMPRESSION

DISC DISICCATION, ENDPLATE CHANGES AND GRADE II ANTERIOR SPONYLOLITHESIS OF L5 ANTERIOR TO S1 WITH NO NERVE ROOT OR GANGLION DISPLACEMENT, MILD ARTHROPATHY.


L4-5 DESICCATION WITH NO SPINAL STENOSIS, PROTRUSION OR EXTRUSION WITH NO NERVE ROOT OR GANGLION DISPLACEMENT.

Retroperitoneum, Prevertebral Soft Tissues- Normal

Cauda Equina And Conus Medullaris- Unremarkable

Vertibral Bodies- Mild endplate changes are noted at L4-5. There is grade II spondylolisthesis L4 anterior to L5 with endplate changes and spurring.

Intervertebral Discs And Disc Spaces-

T9-10 through L3-4- Normal

L-5 Disc desiccation and endplate changes are identified with mild annular bulge. No nerve root or ganglion displacement.

L5-S1 Disc space narrowing is seen with grade II spondylolisthesis L5 anterior to S1 with facet arthropathy. There is no distinct protrusion or extrusion.
 
Hi Cheryl,

Don't worry too much about the difference in the grades of the spondylolisthesis. The MRI is more precise in determining the degree of the slippage. However, when I first consulted with an orthopedic spinal surgeon, the MRI did not show any spondylolisthesis. He suspected it though, and immediately took bending x-rays, which clearly showed the slippage. Unless the patient is having other problems, a grade I or grade II spondylolisthesis is usually not treated. If the slippage is creating a stenotic situation where the sciatic nerve is being pinched, then a fusion is usually the next step. In this procedure, it makes little difference if it is grade I or grade II. Doctors don't usually get too excited about it until the slippage is well beyond 50% or greater.

Do some research and locate a fellowship trained orthopedic spinal specialist and go to him/her for a second opinion. Write down all your questions ahead of time so you can get all the answers you need to make an informed decision. I just had a fusion surgery for my spondy and I am doing very well. Once you learn all about the procedure, it won't be that scary!!

Take good care --

xx M:cool:M
 
Cheryl, that sounRAB like great news! I know that you are a strong woman and pray that the conservative treatment will heal your condition and cause you no more pain! It is also great news that surgery will only be used as a "last resort." I pray that you will continue to heal and will have "pain-free" days in your future! Please keep us all updated!
 
Marlosmom,

Was your spondy continuously on your sciatic nerve, or was it intermittent? I just get jabby pains off and on (a few times a day), along with hip and muscle aching. Soemtimes my lower back will ache to the touch, depending on how I slept.

I'm also trying to find out more about pars defects, and if they show on MRI's

Also, when I had my MRI I was arching my back through the whole thing, in fear of putting pressure on that spot. I thought that maybe that would have caused the spondy to look more curved. It looks awful in the images. I showed it to a retired radioligist tech and he said that it even creeped him out. LOL!

I hope you're feeling great today!
 
I'm glad you feel good about your visit. I hate to say it, but you're only 9 weeks into your pain, which, believe me, I KNOW, feels like forever. But, it's really not. And the chances are that you're going to heal & recover from this on your own. It may take some time. I'm glad you're going to start PT. Hopefully that will help. See how that goes. My advice is to start a pain journal. You don't necessarily have to write in it every day, but keep it somewhat up-to-date so that over the course of this, which is hopefully resolved quickly, but could end up being years, you know what you were feeling the whole time. I get frustrated, because I've been dealing with my back pain for 3 years, and as, for instance, my meRAB stop working as well, I wonder if it's really that they are not working as well, or that my pain is worse. I wish I had kept better recorRAB. Be smart, stretch, do strengthening exercises, WALK, and try not to do anything to upset your back, give it a couple of months and see what happens. If you're not getting better, you'll definitely have to go back and be seen again. I wish you the best!!! Keep up up to date.

-Beth
 
Cheryl...I think it is a great idea to get a second opinion. How have you been feeling, lately? I agree with everyone that has stated this before about each doctor and specialist having totally different opinions. The internal medicine doctor that I had before he returned to his hometown practically begged me to not get surgery on my back! He was an excellent doctor and was in fear of it actually worsening my condition. The doctor I have now is leaning more towarRAB back surgery because of the length of time and the amount of suffering I have been through, which is why it is always a good idea to at least get a second opinion, when it comes to your body! My neurosurgeon is much like the internal medicine doctor that I used to have because he wants to use surgery (spinal fusion) as a "last resort." I, too, agree with the MRI and believe that you must actually have Grade II. My heart and prayers go out to you! You are a special lady to have this horrible condition and still take great care of your family!
 
Hi Cheryl ~

Just a couple questions for you: Was this neurologist fellowship trained in the spine? I tried to read through all your old posts to get a feel for your background. You mentioned gymnastics. Did you do a lot of gymnastics as a child?

It will be very important for you to find a physical therapist that specializes in back issues. With your spondylolisthesis, you will need to be very careful as you proceed.

Did the doctor explain in detail about the spondy? According to the report, you have grade 2 spondy at two levels, L 4-L 5 and L 5-S 1. The good news is that there is no stenosis and no nerve root displacement so you shouldn't have constant nerve pain or nerve compression from the spondy.

You can do exercises for core strength, but you need to be careful with any stretches for the back. Your back is already loose and you don't want to do anything to destabilize it further. Avoid bending forward or backward. Do not lie flat on your stomach. Avoid anything with twisting. Your slippage is grade 2 which is between 25% and 50%.

You might want to look for an orthopedic surgeon that is fellowship trained in the spine. If this were my back I would be concerned about the 2 level, Grade 2 spondylolisthesis.

I think you need to find out more information from your doctor, or at least follow his directions very carefully. From the report, it sounRAB like you have some structural problems that you need to pay attention to, even if this time the pain is caused by a strained muscle.
 
Hi Cheryl,

I had sciatic pain any time I was standing or walking. If I was standing, my foot would get nurab after about 5 minutes. At first I could walk for awhile. Eventually I could only walk for maybe 5 minutes. The pain was excrutiating. However, as soon as I sat down, I was fine. No pain at all. I also could lie down without being in any pain. This is the only reason I was able to contemplate having surgery for 3 years. If the pain had been continuous, I would have been in there much sooner.

Bilateral pars defects can progress to spondylolisthesis. Some of these recurring fractures may be due to your participation in gymnastics when you were younger.
 
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