Help needed for Spondylolisthesis, Herniated disc, Sciatic nerve

[singh]

Hello Dr Young,


I write to you for your expert opinion and advise for my Wife. She recently had a bad fall and hurt her back. I am writing to you the exact MRI report followed by the X-ray report of her spine. Here goes:

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X RAY REPORT OF LUMBOSACRAL SPINE:

LUMBOSACRAL SPINE series including lateral views in the neutral, flexion and extension positions are supplied.

There is an anterior Spondylolisthesis of L5 upon S1, associated with narrowing of the disc space. It measures 11 mm in the neutral position, and 13-14 mm in flexion and extension, suggesting a degree of instability. Correlation with additional imaging is suggested to evaluate for the degree of Spondylolisthesis and its laterality.

The remainder of the visualized structures, other than facet joint degenerative changes with sclerosis at L4-L5, is unremarkable. No lytic or blastic lesions are seen.

IMPRESSION:

Anterior Spondylolisthesis of L5 upon S1 associated, with disc space narrowing, measuring 11mm in neutral position and 13-14 mm in flexion and extension, suggesting a degree of instabilty. Correlation with additional Imaging suggested to evaluate degree and laterality of Spondylolisthesis. Facet joint degenerative changes, L4-L5.

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MRI REPORT OF LUMBOSACRAL SPINE:

History: History of back pain.

MRI of the lumbosacral spine utilizing T1 mixed T2 and stir sagittal and mixed and T2 weighted axial sections reveals the presence of a Grade I Spondylolisthesis at L5-S1 associated with a shallow disc herniation. This is causing significant canal stenosis at this level. The remaining disc spaces and conus are normal.

IMPRESSION:

There is a Grade I Spondylolisthesis at L5-1 associated with a broad shallow disc herniation. The combination of the slippage in the disc herniation is causing significant canal stenosis changes.
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[Wise Young]

Dear Mr. Singh,

The scans suggest that your wife has spondylolisthesis (or slippage of one vertebral body on top of another) associated with a major disc herniation that may be compressing her spinal cord. One of the comments indicated that the bony situation may be unstable. Given these findings, surgery should be considered to repair the vertebral slippage and remove the herniated disc, with the goal of decompressing and stabilizing the spinal cord.

What would happen if one does not do surgery? First, because the injury site is low and involves the thoracic spinal cord, traction will be unlikely to decompress her spinal cord effectively. Second, the spondylolisthetic site may heal in place and she may have a persistently narrow spinal canal. This may take months. During this time, her leg muscles will be weaker due to non-use and bedrest during this . She should get intensive physical therapy and exercise to rebuild the muscles. Third, her pain is likely to continue.

For the above reasons, I would suggest getting a surgical consult, finding the best surgeon possible, and getting this fixed.

Wise.

[singh]

Thanks for the quick reply Dr. Young. If we opt for the surgery, is it a major one? What kind of complications can occur? Are there any statistics available for this surgery done in the U.S.? If yes, where can I check those out? Your help is appreciated. Would you know of the best surgeon available in Canada? Thanks in advance

[Wise Young]

Mr. Singh,

A L5-S1 level is actually below the level of where the spinal cord is (the spinal cord ends at about L1/L2). It is also in the lumbosacral region (as opposed to the thoracic spine). Thus, the surgery should not be very risky. The complications of course depend in part of the surgeon and I don't think that there is a cross-center compendium of statistics on complications of surgery (as you can imagine, this is not something that doctors with poor records of complications will publicize).

Wise.

[Wise Young]

Regarding the best place to get surgery in Canada, I would recommend the University of Toronto at the Toronto Western. I don't know who specifically is doing the spinal surgery in the lumbar area now but they have a good reputation and are very experienced. Wise.

[Wise Young]

Singh, I am copying this topic over the Care Forum where perhaps other people with experience with lumbar surgery can share their experience with you. Wise.