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    Old 08-23-2004, 12:30 AM   #1
    Melody1962
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    Question Spondylolthesis need info

    Hi, My name is Melody and I'm 41. Just found out I have Spondylolthesis at L5-S1. Had MRI 3 weeks ago going to Neurosurgen on 26th. I don't know much about this except that from reading posts here and on the net, I don't want to have surgery. My question is in my MRI report it states that I have moderate to severe bone marrow changes. Is this a common thing? It sounds bad to me. It also states that I have moderate to severe bone degeneration but it doesnt appear to be pressing on my thecal sac?
    What specific questions should I ask the DR.? Also I am out on short term from my work because I do a ton of bending over and lifting at work and my regular Dr. did not want me doing that until I see the neurosurgen. This is not a workmans comp thing so my place of employment won't let me go back on light duty. I'm wondering if I will be able to go back at all?
    My Dr. said they want to send me to physical therapy and might want to do some injections because they think this is pressing on my nervre root. I am currently taking Darvocet for pain. My pain is at it's worst when I'm lying in bed. I can't sleep it hurts to turn over and in the morning I have to walk up my legs with my hands to stand up. It feels like my spine is being shoved into my pelvis! After I am up for awile I can walk around and I actually feel better standing or walking than sitting. Do you think a new mattress would help? I'm considering a sleep # bed. Any and all Info is appreciated.

     
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    Old 08-25-2004, 09:25 AM   #2
    scotty12
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    Re: Spondylolthesis need info

    Melody,
    you didnt say what grade of spondy you have,grade 1 to grade 2 is nothing to rush into surgery from.physical therapy is a must try before considering fusion.it may be difficult stregnthening without proper pain control but you mentioned shots which i assume are ESI's and are usually performed by a pain management dr who may help you out as far as meds go.esi's and pt are pretty standard as far as non invasive tratments are concerned.i personally wouldnt let any dr other than an anesthesiologist stick needles in my back.

    ive had 3 myself to no avail but stregnthening has helped quite a bit.it may take months of exersizing to see any results but when you develop ab strength sitting and any light lifting wont have the consequences you are experiencing now.stretching everyday is very important too.

    as far as fusion goes,it should always be a last resort.especially with disc degeneration at adjacent levels the long term outcome of fusion may not offer the pain relief you would expect.fusion will stabilize your spine and prevent any further slippage at the spondy level but it puts stress on the levels above and below the fusion which sounds like are already in bad shape.

    ive been living with this for a couple of years now, both the spondy and 3 herniated discs,and ill be honest with you it has been difficult.i never stopped working although i only work part time now.

    the problem with fusion is with degenerating disc at adjacent levels, if you fuse 1 level now (L5_S1) the odds of winding up back on the operating table are pretty good.a single level fusion when performed from an anterior approach has roughly 90-95% sucess rate.a multi level fusion doesnt fare quite so well.

    i would ask the surgeon what approach he plans on using and why.also if you havent tried stregnthening yet and he proposes going ahead with the surgery i would be apprehensive to say the least as far as using this neuro.
    also,ask him about the long term expectations regarding the adjoining levels.

    im not trying to scare you but fusion should only be performed after all else has failed.once fusion is attempted you have no other options as far as surgery is concerned except to try and refuse.many people fuse sucessfully but you wont find them on message boards as they are busy getting on with their lives.

    as far as disc degeneration is concerned,most over the age of 30 have some degree of disc degeneration but dont necesarilly have any pain,even with disc bulges.

    i wish you luck and dont throw in the towel just yet.give pt your best shot and take it from there.if you decide to have surgery get more than 1 opinion.
    scotty

    Last edited by scotty12; 08-25-2004 at 09:27 AM.

     
    Old 08-25-2004, 02:08 PM   #3
    Melody1962
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    Re: Spondylolthesis need info

    Thanks for replying Scotty. It says on my report that it is a grade1-2 at the L5-S1. It says there is a bulging disc with a small central protrusion ay L4-5 which produces no effect on the thecal sac at this time.It also states moderate to severe narrowing at L5- S1 along with another disc protrusion in this area. I have no intention of having surgery until all else has failed. I go to the Neuro tomorrow and they are sending me to PT next week I do know that. As far as spinal injections that is something my Dr. mentioned to relieve pain from the disc pushing on my nerves I just wonder how effective it will be. I have been off work for 3 weeks and I'm going crazy. I'm sooo bored and I don't sleep well so I watch T.V. I do try to go for a walk every day. I don't know what the % of the protrusion is yet. I'm just wondering if I'll be able to continually bend over at my job when I do go back. I will keep u posted. Melody

     
    Old 09-02-2004, 08:54 AM   #4
    scotty12
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    Re: Spondylolthesis need info

    melody,
    disc bulges cause distortion of the thecal sac.with decreased disc height there is more pressure on the disc and it is prety common.i have it at all 3 levels where there is bulges or herniations.

    try to be as active as you can as being lethargic is going to cause tightness and most likely increased pain.bending is not good with the spondy issue but as you strengthen your lower body i found i was able to bend without the added pain i experienced in the first few months.

    bulges can heal.it can take a year or more but unless you had a discogram done its unlikely to know if the pain is coming from the bulge at L4-L5 or the instability below.trust me,you dont want to endure a discogram unless its prior to surgery.it is performed to determine what the pain generators are which is done by injecting dye into each disc and increasing the pressure to reproduce your pain.

    good luck at PT and if any exersizes cause increased pain let your therapist know.as you increas your strenght it will get easier but the first few months can be rough.especially ab exersizes.ry and stick with one or two therapists.
    good luck,scotty

     
    Old 09-02-2004, 11:49 PM   #5
    Melody1962
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    Re: Spondylolthesis need info

    Hey Scotty, I just wanted to tell you the the Neuro I saw was a total QUACK! Before he even looked at my x-rays or my report he said we may not be able to help you, You might have the big "C"! He then excused himself from the room and before he did he said he would get back to that. It didn't hit me right away what he meant and after a couple of minutes I was like the bid C that's cancer! So after what seemed like an eternity he came back and asked me alot of questions and then he pulled out the 3 inch screws and started talking about fusion. I said "listen I don't want fusion unless it's the last resort." I then asked him if it would be alright for me to return to work and he said "Well I don't have a crystal ball." Then he refused to write me a Dr.'s excuse for work and then stated the reason I am having all this pain is because I'm having muscel spasms. I said well would a muscle relaxer help that. He said yes but I only prescribe them before or after surgery. I was so furious when I left there. I went to see my Dr. the next day and I said "What kind of a quack did you send to?" She apologised and gave me a muscel relaxer and the paperwork for me to set up my own thearpy and my excuse. I now have the flu so I didn't do to thearpy yet. I'm also having a consult with anestesia Dr. about injections. I know you have been through alot and you've probably looked around alot on the net but I thought I'd mention I saw total disc replacement at Stenum hospital in Germany and I talked to my Dr. about that they are starting to do it conservetively in th US. It looks interesting so I think I'll try to hang on as long as I can before I do anything. I hope you are doing well. Take care and thanks for responding. Melody

     
    Old 09-03-2004, 06:36 AM   #6
    scotty12
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    Re: Spondylolthesis need info

    melody,
    the neuro sounds like a quack.what nerve to even mention cancer and cause you to worry without doing any tests.he should know the effect stress has on pain.ive come across a few surgeons like that myself.if you were to decide to have surgery find a doc you arre comfortable with.

    as far as ADR is concerned ,i have been following the research and it does look promising for multi level problems but as of yet now no trials are being done in the US for instability so for now i guess we are out of luck.
    but i do believe it will be an option down the road.they have done multi level clinical trials in the US with very promising results.

    i agree that holding out is the way to go as long as you are able to function and have some quality of life.too many desperate patients dont have a doc helping them keep their pain under control and feel as though fusion is the only hope they have.ive been there a few times where another week or two of such pain and i would be begging my ortho to operate now.im lucky to have a compassionate pain dr.

    be well,scotty

     
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