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  1. #1
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    Spondylolysis/Spondylolisthesis? (lower back pain)

    Been having a run of bad back pain for the last 4-6 weeks after trying to put a new movement into a weightlifting workout. Went to the general practitioner since I was a couple years past due for a checkup anyway. While there he did some x-rays of my back to see what was up. X-ray clearly showed a small piece broken off the anterior side of L3. I brainstormed the past few years of dumb shit done and drilled down to a time that I stacked up on a pillow line in BC and had to spend the rest of the hut trip laying on the floor. He figured that the piece was stable as it is held in place by ligaments, but figured the trauma required to break it possibly damaged the disc space, and it was irritated from the workout. Fast forward two weeks and it was feeling great again. Good enough that I decided to tackle some yard work that required a ton of shovel time.

    Wake the next day after the yard work and the back feels fine, until I lift something that weighed 5 pounds and twisted with it. Bam done. Been pretty much laid up with pain since then (9 days yesterday). Went to see a specialist yesterday and tell him the whole story, he pulls up the x-rays. He sees the "inconsequential" break that the other doc had seen, but said the GP missed the fact that I have Spondylolysis.

    The break (Spondylolysis) allows the vertebrae and disk to shift forward and pressure the nerve, hence the pain. He said the definitive treatment is fusing the back, but obviously doesn't want to start there. I started on predisone to try and relieve the swelling and allow the disk to move back into it's space. Once that happens, start PT to learn proper movements and strengthening exercises to protect it from movement in the future.

    Radiologists report: Bones: L4 vertebral body limbus deformity. No acute fracture or dislocation. Remaining lumbar vertebral bodies maintain normal height. L5 pars interarticular is defects. 6 mm anterolisthesis of L5 relative S1, which appears stable on flexion and extension imaging.. Intervertebral disc spaces: Mild loss of L3-L4 intervertebral disc space Soft Tissues: Overlying soft tissues unremarkable IMPRESSION: Bilateral L5 pars interarticular is defects, with mild grade 1 spinal listhesis of L5 relative S1. Spondylolisthesis appears stable on flexion and extension imaging. Limbus deformity at the anterior superior corner of the L4 vertebral body, chronic in nature.

    So, long story for my question: Based on that report, did I interpret what I was told correctly? Anyone live with this? What is active life like? Have you had "episodes" of pain from doing too much work /lifting wrong? I mean, apparently, unless I broke it from shoveling (unlikely?), then I've been living an active life with it? I mean MTB has caused me lower back pain since that ski wreck, but I'm able to tolerate it with enough stretching and working of the opposing muscles.

  2. #2
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    I don't know anything but I remembered this thread, might be good to check out.
    https://www.tetongravity.com/forums/...d.php?t=318331

  3. #3
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    Don't know what grade spondy I have, but it's at L5 S1 and bothered me a lot ~15 years ago. Yoga has helped tremendously, I'm able to play hockey, golf, tennis and ski with greatly reduced pain and discomfort.

    Find a studio that you feel comfortable in, and practice. It may kick your ass for a bit, but you'll notice some aspect of some posture is feeling "easier". That's when you feel like some small progress has been made. And my back felt a little better after the first class.

  4. #4
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    Quote Originally Posted by abraham View Post
    I don't know anything but I remembered this thread, might be good to check out.
    https://www.tetongravity.com/forums/...d.php?t=318331
    Damnit! I swear I searched. Reading now.

  5. #5
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    Quote Originally Posted by skuff View Post
    Don't know what grade spondy I have, but it's at L5 S1 and bothered me a lot ~15 years ago. Yoga has helped tremendously, I'm able to play hockey, golf, tennis and ski with greatly reduced pain and discomfort.

    Find a studio that you feel comfortable in, and practice. It may kick your ass for a bit, but you'll notice some aspect of some posture is feeling "easier". That's when you feel like some small progress has been made. And my back felt a little better after the first class.
    Yoga is definitely on the future agenda. And this time I mean it!

  6. #6
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    Spondylolysis/Spondylolisthesis? (lower back pain)

    6 mm is a decent slip, we fixed one yesterday with less than that but it was in a patient with prior L2-5 fusion and we extended it to S1. Work on your core strength and flexibility, avoid spinal surgery for as long as you can.

    Oh, posture is everything, donít let your pelvis roll forward, engage your abs and tuck your butt. Youíll notice a marked difference.

    Sent from my iPhone using TGR Forums

  7. #7
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    My frank commentary is that you are never free of this. It is always lurking as an achilles heel.
    Getting to a level of movement & strength that is your basest level of expectation will require a lot more patience & work than you may imagine right now.
    Is it possible to do better than that? Yes, but do you have the time to be a full time athlete?
    And st johns wort isn't going to make it go away, even if you rub it on every day for a year...
    Sorry that's a bummer statement

    Plan on being exceptionally methodical & patient with your return to movement & strength. Do something everyday that will get you that half inch closer to progress.
    One of my docs said: do not become untrained [he wasn't my neuro, but it was remarkably prescient when he said it]
    I aspire to doing this, but...life...it's a work in progress

    you can say yes to all the stuff you want to do once you're retrained, but dial it down a bit until you understand your thresholds, and, even then, expect to be thoughtful about the thrill-seeking end of the spectrum of your movement

    an example of the long term: I've lost nerve access to a part of my leg and may have permanently lost function for certain specific muscles, and that only happened during a subsequent flare-up episode years later, not the initial injury. Cue the doc in my head & getting untrained...

    if you sit for your job, figure out a way to sit less
    that's what killed my back

    my 2c/n=1

  8. #8
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    I'm going through something like this right now, myself. Sep 2019, lifting an 80 lb package out of the back of my car, something felt wrong. Fast forward, did PT for 5 months, never really got over the discomfort. Talked to my GP (he performed x-rays when first occurred and prescribed PT) and he referred me to Dr. X, a spine surgeon for consult and ordered an MRI. Also spoke to another friend who's also a spine surgeon, Dr. Y. He suggested the MRI as well and asked that I have it sent to him, too for a courtesy second opinion. His last words on it were that, if I wasn't having leg pain, he'd probably recommend I not do anything surgical at this time and keep doing the activities I do (skiing, golfing, mountain biking, hiking, etc.).

    Had the MRI last Tuesday, Dr Y asked where I had it, looked it up and texted me this; "Sorry to hear about [a friend who just died of cancer]. How is [friend's father]? You have a degenerative spondylolisthesis at L4-5. Very fixable with a decompression/fusion. You will do great." Not what I was looking for...

    Just to share, this is the MRI narrative. Any of you dentists have expertise or experience that would indicate that a fusion is in order? I haven't seen Dr. X yet so don't have his diagnosis but when my buddy tells me that, especially after his initial comments, I'm concerned. The major issue apparently is the "Severe spinal canal and severe left-sided neuroforaminal narrowing at L4-L5. Left L4 intraforaminal nerve root compression." Severe doesn't sound good.

    MRI Results:

    MRI LUMBAR SPINE WITHOUT CONTRAST


    CLINICAL INFORMATION:
    Chronic low back pain with left-sided radiculopathy since September
    2019 lifting injury.


    COMPARISON:
    Radiographs, 9/30/2019.


    PROCEDURE:
    Sagittal T2, axial T2, sagittal T1, axial T1, sagittal STIR sequences.


    FINDINGS:
    Alignment: Grade 1 L4-L5 anterior spondylolisthesis, unchanged since
    9/30/2019.


    Vertebrae and vertebral marrow signal: Normal.


    Conus and imaged portions of the caudal cord: Normal.


    Lumbar disc levels: Marked disc degeneration at L5-S1. Mild diffuse
    posterior and bilateral neuroforaminal disc herniation at L5-S1.
    Moderate bilateral L5-S1 apophyseal spondylosis. Mild spinal canal and
    moderate bilateral neuroforaminal narrowing at L5-S1. Compression of
    the L5 intraforaminal nerve roots, greater on the left.


    Grade 1 L4-L5 anterior spondylolisthesis. No L4 spondylolysis. Mild
    diffuse posterior and bilateral neuroforaminal disc bulge at L4-L5,
    greater on the left. Severe bilateral L4-L5 apophyseal spondylosis.
    Severe spinal canal and severe left-sided neuroforaminal narrowing at
    L4-L5. Compression of the left L4 intraforaminal nerve root. Moderate
    right L4-L5 neuroforaminal narrowing.


    Mild left L3-L4 neuroforaminal disc bulge. Small right L3-L4
    neuroforaminal disc herniation slightly deforming the right L3 nerve
    root. Mild bilateral L3-L4 apophyseal spondylosis.


    Mild bilateral L2-L3 neuroforaminal disc bulge, greater on the right.
    Possible small right L2-L3 neuroforaminal disc herniation.


    The L1-L2 level is unremarkable


    The T12-L1 level is unremarkable.


    Mild disc degeneration and bilateral neuroforaminal disc bulges at
    T11-T12.


    Paraspinal musculature and paravertebral soft tissues: Moderate
    bilateral sacroiliac degenerative spurring.


    IMPRESSION:
    1. Mild diffuse posterior and bilateral neuroforaminal disc herniation
    at L5-S1. Compression of the L5 intraforaminal nerve roots, greater on
    the left.
    2. Grade 1 L4-L5 degenerative anterior spondylolisthesis. Severe
    spinal canal and severe left-sided neuroforaminal narrowing at L4-L5.
    Left L4 intraforaminal nerve root compression.
    3. Small right L3-L4 neuroforaminal disc herniation.
    4. Mild bilateral L2-L3 neuroforaminal disc bulge (possible small right
    L2-L3 neuroforaminal disc herniation).
    Last edited by GoldMember; 05-25-2021 at 02:11 PM.

  9. #9
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    My advice re backs--as a patient, not an expert--is to see a PMR (physical medicine and rehab) doc, also called a physiatrist. They can prescribe the proper PT for your particular situation, prescribe non-surgical methods (epidural steroid injections worked for me, or maybe just time), and advise you when surgery is necessary. I wouldn't start with a surgeon. Surgeons love to operate.

    Re yoga, often mentioned in these threads. Yoga hurt my back. See PMR first--learn about what body mechanics make your particular situation better or worse. Than you can figure out which yoga poses to do and which to avoid. To some extent the body does what it needs to do to protect the nerves--by altering posture and stiffening certain muscles. The wrong yoga can undo that. For many back problems, including mine, what MU said--tuck the pelvis (posterior rotation), which is why strengthening the abs helps.

  10. #10
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    ^^ Thanks OG. The PT I went through last year is a PMR. He definitely helped and I was better than I had been before but still had/have chronic pain and some numbness in my left foot. Additionally, Dr. X (my buddy) had initially indicated that he would advise against surgery unless I had pain in my legs. Upon seeing the MRI, he suggested the fusion. I'm going to see Dr. Y once I get an appointment just as a consult at this time. I chose him as he's imminently qualified with a strong reputation and is also known to advise against surgery unless there's no other options and depending on severity. As my MRI indicates, it appears 'severity' is present so, I don't know how this is going to turn out. Thanks for the advice and, believe me, if I can avoid surgery, I certainly plan to.

  11. #11
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    Thanks for the replies so far, it's helping me wrap my head around this. I do have some questions, and I hope they don't come off as obtuse.

    1. I assume that my recent pain is from the load I put on it from the shoveling yard work. Did the disc/vertebrae actually slip some more from the state of weakened muscles? Or did I just inflame the old injury? Basically, did I do more long term damage? It's strange to me that the pain didn't come during the act, but a day later doing something trivial.

    1a. The radiologists report says that it's stable, does this mean that it shouldn't get progressively worse? Or is that possible and even likely?

    2. Why now? I did similar work last summer and fall. I'm guessing this can't be answered.

    3. If it's not a new injury and is just inflammation and irritation to an old injury, why would recovery take so long? I was "trained" previous to this latest bout. I would think that once the irritation/inflammation is relieved it'd be back to normal. But no one has said that to me.

    4. I can't get into see the recommended PT until end of June. What activities are ok? Is pain my guide here? Hiking with small pack? Smooth MTB trails (although position may not allow this). Pushups, air squats, pullups? Just trying to find away to not atrophy away to nothing and the exercises that I google aren't going to cut it.

    5. Any of you carry some high dose pred in you bc kit now in case you have to self extract from somewhere two days in when your back decides to "go out?" Just a thought.

  12. #12
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    1-3:
    I also provoked my first road to surgery shoveling snow.
    My second surgery came after carrying an awkward load where the pain settled in 12-24hrs later.

    Why? I'm not sure anyone can really capture that

    Possibilities:
    Genetic disposition/geometry of spine/location & size of nerve paths
    Age related deterioration
    Lack of fitness/too much sitting/poor form during activity
    Accumulated abuse/deterioration of joint added up to failure
    Activity was straw that broke camels back/one bridge too far
    Lack of fitness for task & luck finally ran out
    etc
    & likely all of the above in some percentage


    Re: the damage -- it's aggregate IMHO (not a doc, just a participant in this terrible experiment)
    the docs can't yet "fix" the spine assembly such that it goes back to OEM status -- they just make it usable/stable, offering a reset to you

    4:
    Do nothing that provokes pain
    If your dog is always at the end of the leash during a walk, get your SO to hold the leash...it's not worth it.

    Work on gentle supported mobility: swim? walk? whatever is absolutely PAIN FREE...there is NO amount that is OK & you can just "deal" with it...you're trying to fix this and get back to much more vigorous excercise
    Yes, the exercises aren't going to help any major muscle groups. They are for stabilizing your back & creating mobility for moving in a balanced stacked way.
    Yes, your overall fitness is going to suffer while you deal with this. It is going to be slow & likely frustratingly so to do it correctly.

    5: Just dial back the potential for getting into trouble. A relapse that reduces you to crawling isn't going to be solved by prednisone in the field...tho fentanyl IS effective (tho difficult to get & still takes a little while to kick in)...ask me how i know

  13. #13
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    ^^ That pretty well sums it up from me as well, especially age-related deterioration and a history of physical activity. As my GP told me, the warranty period on my back has expired.

    As for current activities, I'd recommend backing down for now until you can at least see your PT. Follow their program and recommendations and realize you're going to be frustrated for awhile as you work back into activities you want to do and as directed by the PT.

  14. #14
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    Don't let them keep you on steroids for too long, that is nasty stuff not made for long term use.
    Proper movement is going to be key. I have back problems. Even lifting something light can provoke a nasty response if done incorrectly. That's not going to change. You're probably in better shape than me, with good core strength, so that should help. Anyway, enjoy being able to forecast the weather!
    No longer stuck.

    Quote Originally Posted by stuckathuntermtn View Post
    Just an uneducated guess.

  15. #15
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    Quote Originally Posted by ::: ::: View Post
    1-3:
    I also provoked my first road to surgery shoveling snow.
    My second surgery came after carrying an awkward load where the pain settled in 12-24hrs later.

    Why? I'm not sure anyone can really capture that

    Possibilities:
    Genetic disposition/geometry of spine/location & size of nerve paths
    Age related deterioration
    Lack of fitness/too much sitting/poor form during activity
    Accumulated abuse/deterioration of joint added up to failure
    Activity was straw that broke camels back/one bridge too far
    Lack of fitness for task & luck finally ran out
    etc
    & likely all of the above in some percentage


    Re: the damage -- it's aggregate IMHO (not a doc, just a participant in this terrible experiment)
    the docs can't yet "fix" the spine assembly such that it goes back to OEM status -- they just make it usable/stable, offering a reset to you

    4:
    Do nothing that provokes pain
    If your dog is always at the end of the leash during a walk, get your SO to hold the leash...it's not worth it.

    Work on gentle supported mobility: swim? walk? whatever is absolutely PAIN FREE...there is NO amount that is OK & you can just "deal" with it...you're trying to fix this and get back to much more vigorous excercise
    Yes, the exercises aren't going to help any major muscle groups. They are for stabilizing your back & creating mobility for moving in a balanced stacked way.
    Yes, your overall fitness is going to suffer while you deal with this. It is going to be slow & likely frustratingly so to do it correctly.

    5: Just dial back the potential for getting into trouble. A relapse that reduces you to crawling isn't going to be solved by prednisone in the field...tho fentanyl IS effective (tho difficult to get & still takes a little while to kick in)...ask me how i know
    Good info. Anybody willing to share their age and when this started? I'm 46, mine happened on a hut trip 4 years ago. No pain down legs, no numbness at any point yet.
    I'm glad you guys are responding, but hate what you're saying. I mean, everything provokes pain at this point, getting dressed etc, even with the prednisone. Like I said, I can't get into the therapist for another month, so I hate the limbo of what is too much. Think my HSA will cover lawn care ?

  16. #16
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    Quote Originally Posted by zion zig zag
    5. Any of you carry some high dose pred in you bc kit now in case you have to self extract from somewhere two days in when your back decides to "go out?" Just a thought.
    Nothing but nsaids for me, but if I had some rx leftovers or a friend with spares I would feel glad they were available if needed.

  17. #17
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    Quote Originally Posted by zion zig zag View Post
    Good info. Anybody willing to share their age and when this started? I'm 46, mine happened on a hut trip 4 years ago. No pain down legs, no numbness at any point yet.
    I'm glad you guys are responding, but hate what you're saying. I mean, everything provokes pain at this point, getting dressed etc, even with the prednisone. Like I said, I can't get into the therapist for another month, so I hate the limbo of what is too much. Think my HSA will cover lawn care ?
    Mine started initially about 12-13 years ago on a cat trip where I hit a compression pretty hard. Took about six weeks to heal to where I felt normal. Then, in Sep 2019, I was pulling a heavy package out of the back of my car and I think that's the trigger to my current slippage. I'm 64 so initial injury, I was about 51 or 52.

  18. #18
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    Quote Originally Posted by GoldMember View Post
    Mine started initially about 12-13 years ago on a cat trip where I hit a compression pretty hard. Took about six weeks to heal to where I felt normal. Then, in Sep 2019, I was pulling a heavy package out of the back of my car and I think that's the trigger to my current slippage. I'm 64 so initial injury, I was about 51 or 52.
    Sounds very similar then. Good luck on your next consult.

    Has anyone done the exercises from "Foundation" https://www.amazon.com/Foundation-Re...34797885&psc=1

    It's been recommended by several sources, without the knowledge of actual diagnosis, and it seems like some of the extension exercises might be antithesis of the injury?

  19. #19
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    ZZZ - Unfortunately I have nothing to offer but vibes. Sounds rough, good luck

  20. #20
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    1st significant back issue leading to surgery 2004 at age 33
    2nd was 2019 at age 48

    on the good side, i did manage to train up & did a half ironman in between those dates (2008), so recovery is definitely doable...you just can't go nuts too fast (& can't get complacent & let it slide after)

    i'm back on the build-up process again; my last two winters have been limited tho getting better
    no fusions to date & def trying to avoid further damage cuz that's next if it happens again
    Last edited by ::: :::; 05-26-2021 at 02:03 PM. Reason: date corrected

  21. #21
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    Quote Originally Posted by ::: ::: View Post
    no fusions to date & def trying to avoid further damage cuz that's next if it happens again
    What surgery did you get that wasn't a fusion if you don't mind me asking? And so in your mind, my latest 'episode' probably did result in further damage and not just an irritation of old injury?

  22. #22
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    Quote Originally Posted by Dantheman View Post
    ZZZ - Unfortunately I have nothing to offer but vibes. Sounds rough, good luck
    Thanks man, I appreciate it.

  23. #23
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    Quote Originally Posted by zion zig zag View Post
    Sounds very similar then. Good luck on your next consult.

    Has anyone done the exercises from "Foundation" https://www.amazon.com/Foundation-Re...34797885&psc=1

    It's been recommended by several sources, without the knowledge of actual diagnosis, and it seems like some of the extension exercises might be antithesis of the injury?
    On the exercises, on one of the websites I looked at, they recommended working core with flexion exercises and avoid extension as the latter exacerbates the injury. So, you're probably right, extension would seem to be the antithesis to better recovery.

  24. #24
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    Quote Originally Posted by GoldMember View Post
    On the exercises, on one of the websites I looked at, they recommended working core with flexion exercises and avoid extension as the latter exacerbates the injury. So, you're probably right, extension would seem to be the antithesis to better recovery.
    For example the first exercise in this video:

    https://m.youtube.com/watch?v=4BOTvaRaDjI

    Is that flexion or extension?

  25. #25
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    Quote Originally Posted by zion zig zag View Post
    What surgery did you get that wasn't a fusion if you don't mind me asking? And so in your mind, my latest 'episode' probably did result in further damage and not just an irritation of old injury?
    1st surgery :: micro-discectomy + laminectomy at L4-L5
    they removed a chunk of disc & basically grind a space for the nerve out of the vertebrae

    2nd :: same at L5-S1
    surgeon commented that there wasn't a lot left to grind at L4-L5 if further was needed, so fusion likely

    i've also had issues at C6-C7 -- no surgery tho & zero idea if these are related in any way


    re: your issue
    remember I'm no doc -- take my input as n=1 and not educated beyond going thru my own issue
    "damage" is my word & not purely accurate
    my impression/experience is that these episodes never rebound to full strength so there is a kind of aggregate damage
    (ie, I now have two discs that were herniated & trimmed down so those joints are not acting in the way they should)
    what sort of impact you have is best explored with imaging & your med team

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