I just want an opinion from folks who have been there. I have had excruciating back pain since Jan. 16. I had am MRI on Feb. 8. I took the MRI disc to the Neurosurgeon. He looked at it and told me I have a fracture which caused shifting in my spinal column at L3.
When I got the Radiologist's report, it said there was grade 1 spondylolisthesis (shift towards stomach) at L3 and slight anterolisthesis (shift towards the back) at L4. [U]There is no evidence of fracture[/U].
Now, I think I believe the Neurosurgeon over the Radiologist about the fracture. Am I being silly?
Location: San Francisco, California, United States
Re: Conflicting MRI
I suspect that at some point in the past, you fractured the pars interarticularis, leading to spondylolysis, which has now progressed to spondylolisthesis, described as "shifting" by the neurosurgeon. I would not leap to the conclusion that the two doctors have entirely different opinions, but different ways of explaining the same phenomenon. The radiologist noted the current problem, and the neurosurgeon was explaining how you got to your current problem. Unless, of course, the neurosurgeon indicated that you fractured a vertabra, which would be a very different thing.
Did the neurosurgeon discuss the current shifting/spondylolisthesis and any recommendations for preventing further damage? Do you have another appointment with him to clarify?
I think it is likely that the two are saying the same thing. The neurosurgeon just chose to explain it in the way he felt was easiest for a patient to understand without using the words spondylolisthesis, retrolisthesis, and anterolisthesis....all words that no one remembers or necessarily understands.
A spondylolisthesis can be caused by several circumstances. It can be congenital; it can be degenerative and it can be caused by a stress fracture on one side of a vertebra or another (isthmic). This particular type happens most often with adolescent athletes who participate in sports where the spine is repeatedly put into extension -- sports like gymnastics, diving, figure skating, dance, and also contact sports like football. The stress fracture can occur without any symptoms and it can linger for decades before finally causing some symptoms of pain or discomfort. One study indicates up to 80% of those with this type of stress fracture are unaware of it. It is most common a little lower than yours, most commonly at the L5-S1 level, followed by the L4-L5 level...but it can happen higher up as well.
A spondylolisthesis is graded from 1 to 4, with grade 1 being the least amount of slippage, from 0 to 25%. It is usually dealt with conservatively, through oral medications and a course of physical therapy. If there is severe nerve compression caused by the slippage, then surgery may be indicated, which is almost always a fusion.
What happened on Jan. 16th that started this pain? Did you have any pain previously at this level?
Thanks for the replies! My concern was that the Neurosurgeon said I had a bilateral pedicle [U]fracture[/U] of the L3 vertebra which caused shifting in the spine. The Radiologist said [U]there was no evidence of fracture[/U]. How could my spine shift, all of a sudden like this, at 60 years old, if there isn't a fracture? It all locks together so this can't happen spontaneously. I can feel the difference with my hand from what it was before Jan. 16.
The Neurosurgeon said it would never heal on it's own unless I wanted to be stuck in a recliner for 6 months. I'm having surgery March 1st. I'm pretty sure since the Neurosurgeon actually had the films he knows what he's talking about and he even brought out a model to show me what happened. I'm glad he didn't use "the words spondylolisthesis, retrolisthesis, and anterolisthesis....all words that no one remembers or necessarily understands."
He said it's very unusual without some sort of trauma but nothing about me is normal, LOL.
I still believe there is far less difference in the two opinions than you are thinking...and that it is a matter of language. I think the neuro is talking about a pars fracture which is more like a stress fracture than what we typically think of as a fracture as in "broken bone."
The pars is a little bone that connects the upper and lower bones that make up the facet joint, and it is the bony part that one can feel when running a finger down the "back bone." Probably it developed a crack many years ago, and as you aged and the spine showed some signs of arthritic change and degeneration, it allowed this pars to shift slightly. A grade 1 spondylolisthesis is not a big shift in the spinal column.
I would be more interested in the rest of the radiology report. Do you have a copy of it and can you post it here? I imagine that you have some spinal stenosis in this same area that is contributing to your pain.
What surgery is the neurosurgeon recommending? Do you plan on getting at least another opinion from a different spine specialist? Before undergoing major surgery, it is always a good idea to get at least one more opinion.
Again, were you involved in an accident or just why is there a divide between your back prior to Jan 16 and after?
Have you been checked for osteoporosis? Have you had MRIs in the past? It is possible the pedicle fracture has been there for a long time, but was just asymptomatic. With the passing of time, the supporting facets may have degenerated, allowing for this segment of the spine to slide.
I think you hit the nail on the head with the fact that the Radiologist was talking about now. I really think I fractured it a long time ago. I've had to baby my back or it was very painful for years. On January 16th, I think it shifted causing the excruciating electrical & referred pain. It was misdiagnosed as a kidney infection by my GP from the 16th until Feb. 8 when I had the MRI. I was lifting a large load of laundry when it began hurting on the 16th. I've been the caregiver for my mother since July 2010 ... helping her get up, lifting the wheelchair into the car, etc. I may have reinjured an old fracture.
The Neurosurgeon did back surgery on my husband a few years ago but we first met him 30 years ago when my daughter had to have a shunt for brain swelling. Who has a "family" Neurosurgeon. Also, we are close friends with another Doctor who went to Med School with him. She HIGHLY recommends him. He's done surgery on that doctor friend and her husband. The Neurosurgeon said the two little "wings" that hold the vertebra in place were fractured but he didn't say when. He said they never heal in adults because it grows so slowly & movement reinjures it. I really have complete confidence in the Neurosurgeon.
I had a bone density in March 2010 and they said everything was normal. If I do anything but sit in the recliner now I'm in bad pain. Sometimes even just sitting, I'm in pain. This is a 10 out of 10 pain. If they would have offered to cut out what was hurting on Jan. 16th I would have agreed.
Thanks, very much, for your help! I do have another appointment with the Neurosurgeon tomorrow. I intend to ask him the same questions I did here plus a bunch more.
OK, that makes sense. I imagine you have stenosis and sometimes the facet joints wear away a bit and it can allow some slippage as well, and it doesn't always show up on MRI imaging. That was the case with mine.
You will need help after the surgery. You will probably not be able to lift your mom again...oh, I read your post again. You'll be able to lift the wheelchair...just not your mom. You'll have a lifting weight restriction of a gallon of milk at the beginning, post surgery....
The Following User Says Thank You to teteri66 For This Useful Post: weesab (02-21-2012)
I'm glad I retired last year. I would probably never be able to lift some of the BIG FAT tax files I used to work with. Thanks for the info about the weight restriction. That is one of my questions for the appointment tomorrow. So ... how are you post surgery (for how long?) or did you have a much different situation?
My situation was different, to some extent. I had a spondylolisthesis at L4-L5...at least that was the original diagnosis. I had a one level fusion for that in 2008, which was medically successful, but it never resolved my pain. A year later, I had a second smaller surgery, which briefly resolved my pain...but a couple months later, things were just as bad as before I ever had any surgeries. Things get complicated at this point and the story is long...but eventually I had another fusion, this time 3 level from L3 to S1 in June 2010 which finally resolved my issues. I was very lucky. Most revision surgeries do not turn out so well.