a patient suffering from bilateral spondylolysis at L5 with grade 1 anteriolisthesis.Is this condition progressive?what is the best treatment for his chronic backach?Is surgery needed?

I am 15 years old and have this stupid problem . The doctors say to just sit at home and spend my life without physical activity . Is this the end?

i appreciate your medical oppinion and I see my nuerosurgen in a week and my specialist suggested to him in the refural that I have a spine fusion as all the symptoms are as you have just described. good luck. greg

Hi Cary,
After having a CT Pelvis scan, I was told I have lower lumbar spine degenerative type changes. 2 mm grade 1 anterolisthesis of L5 on S1. Bilateral spondylolysis at this level is also suggested on the axial and sagittal as well as coronal views as well. About 2 years ago I had 2 epideral injections that really helped at that time. I have been seeing a chiropractor on a monthly basis for that same 2 years. Lately I have been having discomfort in my lower back. I am a 60 year old male and am on my feet all day at my job. What can I do to end this pain and discomfort.

My Wife is afraid she might not be able to come off a ventolater after a fusing operation on her spine because she has COPD.

I have been suffering with low back and leg pain now for over 2 years. I was diag. originally with a slight bilaterial spondylosis with no encroachment. I continued to work and symptoms got progressively worse. Walking became more painful. I saw a surgeon and he showed me the bilaterial fractures and radial tears in my l4-l5 s1 disc and said it required surgery. I have a sever reaction to anthesia so that has to be my last option. I continued to work in a physical job and not only did walking get harder but sitting and standing for any length of time became so very painful. I had a ct scan done and it showed chronic bilaterial pars defect with severe left and moderate right encroachment of exiting nerve root. I have tried physical therapy,decompression treatment and am not unable to work because I am unable to maintain a position(standing,sitting or standing)for more than just a few minutes. I did a flex xray laying down and it showed the spine to be stable but after I had one standing it showed that on flex and extention it was stable but when in neutral position it progressed to a grade 2. Now I have been telling the dr.s that sitting and standing (any upright position) the pain increased and they just didnt seem to listen. My archilles reflex in my left leg is now severly diminished and even my left leg is somewhat smaller than my right. I have a limp and all symptoms have worsened.I have really lost faith in doctors now and dont know what to do.They want me to go in for injections but isnt this just a bandaid?If I have a section of my spine that is unstable when standing is that going to change when they do injections or just cover up the symptoms for a time thus creating a greater chance of further slipage?Does anyone have any clear answers?

Hi Anonymous-

I'm sorry your friend is going through this, because it is very painful. To start, let's identify some terms for those who may not be familiar:

Spondylolisthesis-This means you vertebrae are sort of sliding around a bit. If you imagine a spine from the side, the vertebrae are all stacked nicely on top of each other with little cushions in between. Now imagine one of them sliding forward a bit out of alignment while the others stay in place. This is anterolisthesis/spondylolisthesis. As you can imagine, this puts stress on the levels above and below when this vertebrae pulls forward out of alignment. It also means there can be pressure on the spinal cord, which is running up through all those vertebrae. One of them slides forward, and it can pinch the cord.

Spondylolysis-This means a pars fracture. When you look at a vertebrae from behind, you see the little piece of bone that sticks straight back at you that you can feel when you feel your back. That back part connects to the big body of the vertebrae. If you were holding that back part, just in front of your fingers on either side are the pars. That's just the name for the two sides holding that back part to the body of the vertebrae. Spondylolysis means you have a pars fracture, so the spine again can slide around like it shouldn't and can again pinch the spinal cord or the big spinal nerves.

Basically, it sounds like your friend may have an unstable spine. Sometimes if those fractures are very small, they will try rest and bracing to let them heal on their own, like a broken leg in a cast. But often if your back is unstable and sliding around, you put your spine at risk. Any pinching or pressure on your spinal cord can cause dramatic permanent problems. so if it has been two years, it is time to revisit treatment.

Often chronic spondylolistheis requires surgery. They usually will do a fusion. This means they take a little piece of metal and often some bone either from your hip or a cadaver bone and they connect the two or three vertebrae that are sliding around together. Picture those vertebrae again. They take a very small rectangle of metal and screw the top into one vertebrae and the bottom into the other. That steadies them because they are connected. Then they use a little bone graft and a compound that helps grow bone to encourage them to grow together, like a broken bone would. This stabilizes the area by connecting the vertebrae and encouraging them to grow together. They will be stable and strong.

This is a very common surgery and often has really good results. You want to go to a surgeon who does a lot of them, because that is the surgeon who will be better at it. Practice makes perfect, even for surgeons. There will also be physical therapy to support the back. The therapy goals will be to correct posture, and strengthen the muscles that hold the back in place.

Any time your back is unstable, you risk your spinal cord. I hope this helped explain everything. If you have further questions, feel free to ask. This area is one of my specialty areas as a nurse. I'll be happy to explain further. Also, see our back/spine section here on the site.

Medline (through the National Institutes of Health) has a spine section: http://www.nlm.nih.gov/medlineplus/spinaldiseases.html and even a video of a spinal fusion surgery: http://www.orlive.com/jeffersonhospitals/videos/lumbar-laminectomy/transforaminal-lumbar-interbody-fusion?view=displayPageNLM