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Old 03-14-2004, 10:58 AM   #1
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Grade II spondylolisthesis

My son's doctor told him that injections might help him. This is what the MRI showed. He had to quit his job Friday because he cannot do the (manual)work anymore. I can't understand how injections could work for this, but what do I know? He is only allowed one consult with his insurance and I don't know whether to have him go to the Spine Clinic at the U of PA or directly to a neurosurgeon. Any suggestions. He's 34.

Bobi


Here what the MRI says (encapsulated):

There is grade II spondylolisthesis of L5-S1 associated with spondylolysis. There is slight retrolisthesis of L4 on L5. There is marked loss of disc height at L5-S1 associated with these findings, and there is a reactive marrow pattern, which is subacute. There is diffuse disc bulging at L4-5 and L5-S1 with a radial tear of the L4-5 annulus. there is distortion of the spinal canal due to the spondylolisthesis.

Impression:

There is grade II anterolisthesis of L5 on S1 associated with spondylolysis and advanced facet hypertrophy contributing to rather (and the next part is underlined) marked bilateral L5 neural foraminal narrowing and borderline canal diameter at this level. Otherwise mild bilateral L4-neural foraminal narrowing due to facet hypertrophy.

 
Old 03-14-2004, 09:30 PM   #2
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Re: Grade II spondylolisthesis

I had Grade1 spondylolthesis and broken hardware in my back. Also I have a fusion about L4 to T11 that never took right. I've had physical therapy and injections. Nothing has worked yet. I also had to quit my job due to the pain. I don't suggest the injections. I feel I was used just to make the doctors richer! This has gone on approximately 2 years and I still don't have any good answers. I suggest he get some more opinions as I am also trying to do. Wish I had the right answer, sorry!

 
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Old 03-14-2004, 09:37 PM   #3
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Re: Grade II spondylolisthesis

[QUOTE=Dwayne3]I had Grade1 spondylolthesis and broken hardware in my back. Also I have a fusion about L4 to T11 that never took right. I've had physical therapy and injections. Nothing has worked yet. I also had to quit my job due to the pain. I don't suggest the injections. I feel I was used just to make the doctors richer! This has gone on approximately 2 years and I still don't have any good answers. I suggest he get some more opinions as I am also trying to do. Wish I had the right answer, sorry![/QUOTE] I have been told by a doctor that he could remove my hardware and fuse me at L5-S1 and refuse L4-T11 and put in newer hardware but he said I would probably have to have a morphine pump as well. I've been tried on all kinds of pain meds and I've had nothing but bad side affects so I fear this thought. He also said that injections if they do work , its only for about a week.

 
Old 03-16-2004, 05:37 AM   #4
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Re: Grade II spondylolisthesis

I just had to add that injections are'nt a waist of time for everyone, I've had 2 injections with some much needed relief. It's different for everyone so don't be discouraged! I get my next injection in 3 weeks and I hope to get through the summer a little happier...hoping I can get through the summer until another possible surgery in the fall. (I have grade 1 spondylolthesis) Well good luck, keep us posted.

 
Old 03-16-2004, 05:43 PM   #5
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Re: Grade II spondylolisthesis

<There is grade II anterolisthesis of L5 on S1 associated with spondylolysis and advanced facet hypertrophy contributing to rather [U]marked bilateral L5 neural foraminal narrowing[/U] and borderline canal diameter at this level. Otherwise mild bilateral L4-neural foraminal narrowing due to facet hypertrophy.><There is diffuse disc bulging at L4-5 and L5-S1 with a radial tear of the L4-5 annulus.>
The anterolisthesis of L5 on S1 basically means the L5 vertabrae has collapsed onto S1. Injections will NOT help that. The marked forminal narrowing will NOT be helped by injections. The radial tear of the annulus will NOT be helped by injections.
I would whole-heartedly agree he needs seen by a neuro, not an ortho, ASAP. The sooner he gets appropriate treatment, the better his chances for recovery. U of PA has some awesome orthos, but I think the neurosurgeons would be a better choice.
Did he injure his back lifting? In a fall? Other than pain of the back, other symptoms?

 
Old 03-16-2004, 06:14 PM   #6
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Re: Grade II spondylolisthesis

I would whole-heartedly agree he needs seen by a neuro, not an ortho, ASAP. The sooner he gets appropriate treatment, the better his chances for recovery. U of PA has some awesome orthos, but I think the neurosurgeons would be a better choice.
Did he injure his back lifting? In a fall? Other than pain of the back, other symptoms?[/QUOTE]

His spondylolithesis is congential. We don't know why it became worse. His work involved lifting so it might have been that. Who knows? *My* rheumatologist reviewed the MRI as a favor to me and said that he would pursue the conservative approach first with the Spine Clinic at the U of PA. They are physiatrists. Both he and his family doctor said that injections might help his particular problem.

His main symptom is sciatica which extends down his left leg.

Any other input is welcome. Thank you.

Bobi

 
Old 03-16-2004, 06:26 PM   #7
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Re: Grade II spondylolisthesis

[QUOTE=BobiM -- *My* rheumatologist reviewed the MRI as a favor to me and said that he would pursue the conservative approach first with the Spine Clinic at the U of PA. They are physiatrists. Both he and his family doctor said that injections might help his particular problem. >

*personally* I dont have a lot of faith in physiatrists when it comes to annular tears. They are an entity unto themselves! Very rarely have seen conservative treatment work on a tear. But, ya never know, right?

 
Old 03-17-2004, 04:50 PM   #8
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Re: Grade II spondylolisthesis

What they are saying is that it's not the tear itself that is causing the pain but the nerve being irritated because of the inflammation around it so possibly that is why they both mentioned injections. In other words it seems that the narrowing is from inflammation. Everything you have said makes sense to me. It's hard to know what to do.

Thank you for your input.

Bobi

 
Old 03-17-2004, 07:10 PM   #9
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Re: Grade II spondylolisthesis

<A radial anular tear is any anular tearing that begins within the center of the disc (nucleus pulposus) and progresses in an outward or radial direction. Radial anular tears are strongly associated with disc degeneration (3) and are often a consequence of the natural aging phenomenon which occurs in every disc; somebut are thought to precede disc degeneration if their origen was from trauma. Nuclear ‘cleft’ formation, which are cracks that occur within a degenerated nucleus, are the precursors for the formation of a radial tear. With time and/or trauma these nuclear clefts will progress outwardly (radically) in a parallel or obliquely parallel fashion. Radial tears usually occur posteriorly in the L4 and L5 disc, and love to occur in the L5 disc. In fact the posterior L5 disc shows a 50% higher occurrence rate for radial tears than any of the other five lumbar levels (3). Occasionally, radial tears will merge into a pre-existing rim-lesion or concentric tear in the periphery. This merger often results in the appearance of an HIZ (High Intensity Zone) on MRI, which is the least invasive way to diagnose an anular tear.
It is important to understand that NOT ALL RADIAL TEARS ARE PAINFUL, and that they are often found in asymptomatic patients (21). Why some tears are extremely painful and some aren’t, is still not completely understood. The current theory states that if nuclear material migrates into the outer region of the anulus, which is well innervated with pain sensitive nerve fiber, a chemical irritation and inflammation process occurs around these now exposed nerve fibers and causes discogenic pain. Another theory is that the degenerated and damaged nucleus no longer supports its share of the axial load of the body. The outer anulus now must support more load than it is designed to handle. Not only will this extra load cause further degeneration of the disc but it will irritate the inflamed nerves in the outer anulus, hence causing discogenic pain.

Defintion
The annulus is the fibrous ring of the disc structure which surrounds the centrally located soft nucleus of the disc. The nucleus and annulus function together to create a pressurized structure that acts as a shock absorber. The annulus is a ligament and like any ligament in the body can be torn. Tearing of the annulus can produce pain because the annulus has pain fibers within its structure. Many episodes of low back pain are probably tears in the annulus.

Diagnosis
The diagnosis of annular tearing can be made on MRI imaging but the definitive diagnosis is made on CT-discograms where dye is injected into the nucleus of the disc leaks out into the torn area of the annulus.

Non-Surgery Treatment
Treatment can consist of time to reduce symptoms, physical therapy, bracing, medications, etc.

Surgical Treatment
In very selected situations, the symptoms from the annulus may be treated with intra-discal electrothermal treatment. Occasionally, patients have enough persistent pain from annular tears and internal disc disruption to undergo a fusion of the disc space at the level of the tear.

Prognosis
The prognosis of annular tears is generally the prognosis of low back pain. Annular tears can be the precursor of the herniated disc.

 
Old 03-17-2004, 07:19 PM   #10
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Re: Grade II spondylolisthesis

What Is It?
Spondylolisthesis occurs when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine. The symptoms that accompany a spondylolisthesis include pain in the low back, thighs, and/or legs, muscle spasms, weakness, and/or tight hamstring muscles. Some people are symptom free and find the disorder exists when revealed on an x-ray. In advanced cases, the patient may appear swayback with a protruding abdomen, exhibit a shortened torso, and present with a waddling gait.

Spondylolisthesis can be congenital (present at birth) or develop during childhood or later in life. The disorder may result from the physical stresses to the spine from carrying heavy things, weightlifting, football, gymnastics, trauma, and general wear and tear. As the vertebral components degenerate the spine's integrity is compromised.

Another type of spondylolisthesis is degenerative spondylolisthesis, occurring usually after age 50. This may create a narrowing of the spinal canal (spinal stenosis). This condition is frequently treated by surgery.

Diagnosis: A routine lateral (side) radiograph taken while standing confirms a diagnosis of a spondylolisthesis. The x-ray will show the translation (slip) of one vertebra over the adjacent level, usually the one below. Using the lateral (side) x-ray, the slip is graded according to its degree of severity. The Myerding grading system measures the percentage of vertebral slip forward over the body beneath. The grades are as follows: Grade 1: 25% Grade 2: 25% to 49% Grade 3: 50% to 74% Grade 4: 75% to 99% Grade 5: 100%* *Complete vertebral slippage, known as spondyloptosis.
Treatment: If the spondylolisthesis is non-progressive, no treatment except observation is required. Symptoms often abate once precipitating activities cease. Conservative treatment includes 2 or 3 days of bed rest, restriction of activities causing stress to the lumbar spine (e.g. heavy lifting, stooping), physical therapy, anti-inflammatory and pain reducing medications, and/or a corset or brace. A physician may prescribe a custom-made corset or brace. These are made by an orthotist, a professional who takes the patient's precise body measurements, which may include making a cast from which the molded orthoses is made.
Surgery: Surgical intervention is considered when neurologic involvement exists or conservative treatment has failed to provide relief from long-term back pain and other symptoms associated with spondylolisthesis. A spine surgeon decides which surgical procedure and approach (anterior/posterior, front or back) is best for the patient. His decisions are based on the patient's medical history, symptoms, radiographic findings, as well as the grade and angle of the vertebral slip. A variety of surgical treatment options are utilized. You should discuss what is best for your condition with your spine surgeon.
Recovery: Whether the treatment course is conservative or surgical, it is important to closely follow the instructions of your physician and/or physical therapist. Avoid heavy lifting, stooping, or certain sports such as football or high impact exercise (i.e. running, aerobics). Any doubts concerning vocational and recreational restrictions should be discussed with your physician and/or physical therapist. They will be able to suggest safe alternatives to help reduce the risk of further back problems. Keep your weight close to ideal, continue to follow the exercise program designed by your physical therapist at home, learn how to pick up things off the floor correctly, as well as other 'safe' movements.

 
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Old 03-18-2004, 08:24 AM   #11
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Re: Grade II spondylolisthesis

Thanks you for that valuable information.

Bobette

 
Old 03-27-2008, 08:20 AM   #12
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thegrando HB User
Re: Grade II spondylolisthesis

what doe's this all mean.13mm grade 2 spondylolisthesis@L4-L5with suspected bilateral L4 defect's chrouic wedge compression fracture deformity of L5 vertabra body. am i going to need surgey.please help

 
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