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Grade 1-2 Spond 10mm anterior slip, going on 3 years HELP!

From: ouch123 - on 04/02/2011 3:38pm

Hi!

First time poster, but have been looking up the discussions here since I found out I had Congenital Spondy and my first disk herniation in 2005. (L5/S1).

I was first diagnosed as having a mild slip, GRADE 1 Anterolisthesis and Spinal Stenosis in 2008. Now, in 2011 (this past friday) I had an MRI and X-ray. Have not been able to go over the MRI with doctor, but can see an obvious Herniation at the L5.

The X-ray reports a 10mm slip, Grade 1/Grade 2 Anterolisthesis (26% to 50%), and narrowing of the disk space.

On top of that- I have servere osteoarthritis and adult ClubFeet complications and do not remember a time in my life when I was pain free.

When I saw my doctor before the weekend, he said that anything more than a 3mm slip would require immediate spinal fusion surgery. My guess is he came to this conclusion based on my history, and other medical (arthritic) complications.

Anyone else have a 10 milimeter slip that required immediate/emergency spinal fusion surgery? I just moved to a new town, and don't know anything about the doctors here. I am fine having surgery, no worries about that aspect (have had 11 starting at age 5 mos), but am concerend about having time to find a Good doctor if I am being told I need emergency surgery.....

Thanks!

ps- sorry for the disjointed post, so many worries and thoughts and nerves are running around in my head.... :)

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on 04/06/2011 11:06am

No Surgery for now, PT and Injection to start... Hopefully will be able to put off surgery for 3 to 6 months!

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on 04/06/2011 4:32pm

Where do you currently reside? I had emergency surgery in 1999 at Campbell's Clinic in Germantown TN. My doctor was Dr Warner and he did a great job. When diagnoised, my slip was at 80% and considered a grade 4. Surgery was perfromed within 2 weeks.

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on 04/09/2011 2:18pm

I had a 8mm slippage between my S1 and L5. I seen 3 Dr's and they all said the same thing; I would not need sugery unless the pain affected my daily activities. I went ahead with the surgery, it's been 10 days and was not nearly as bad as everyong said it would be. I started walking 1-2 miles a day by day 4. So I think I'm doing great. If I were you I would take my films and MRI and get a 2nd and 3rd opinion. I don't see why one Dr would say you need Emergency surgery unless other stuff was going on. It shouldn't be based on the amount of the slippage, but the amount of pain you're in. Hope this helped!

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on 04/11/2011 1:28pm

Hi!

Thank you for the comments/advice. I am going to go with the injection for now because there is no movement with flexion or extension, so at least the slip is stable. I was also born with another congenital condition, and have severe osteoarthritis- so it is often hard to discern when the pain is a result of my back and when it is the result of the arthritis. The plan for now is to give it 3 or so months and then go for my third opinion-- Surgery is a big deal, I have had 11-so if i can put it off for as long as possible I definitely will.

Again, thank you and best of luck to you!

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on 04/11/2011 2:39pm

Hi! I have a so-called stable lumbo-sacral spondy with a compressed disc. Over the last 2 years the pain has become very bad so i had X-Rays done 2 weeks ago, which show it is now at the beginning of stage 2 now. This means it has slipped very slowly and slightly since the last X-Ray a few years ago when they said it was Grade 1. I think most of the pain is due to the intervertebral disc being compressed, and not due to the spondy. I think it is best to put off surgery as long as is possible, and to manage conservatively with pain meds/injections as long as you can. And get exercises from your biokineticist or physio to prevent further slippage. A Grade 2 spondy is not a severe spondy. When or IF the psondy has gradually slipped to such an extent that it is called a severe spondy and there are significant neurological symptoms (for example the leg going numb), then it might be more faesible to have the surgery. But what is important is to remember not to do the surgery only to help with the pain, because there is NO GUARANTEE that surgery will decrease the pain (research has actually shown this). Once you have had surgery, there will be foreign objects in your body....which may also lead to pain. I am not having surgery until I can't walk anymore!! Good Luck!

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on 08/04/2011 3:32pm

The responses given you so far are good. A grade 1/2 (10mm) spondy. alone is no emergency. However, you have lot of complicating factors. I have had a similar situation as far as the spondy. with stenosis (there almost always is if you are not a young person). Mine moved from 8 to 10 mm over a few years and I've been dealing with leg pain for 10 years. Epidurals (3 per year) were successful for the past 5 years at controlling the inflammation and relieving the pain, but the past 6 mos. the epidurals stopped working. Everyone, professional and non, that I talked to suggested avoiding surgery if other more conservative measures helped "enough". "Enough" pain relief is a judgement call based on you pain level and life-style desires.
Fusion "success" rates are pretty good for a spondy with radiating leg pain, because once you unpinch the nerve, function can return (if you haven't waited too long). I'm a rather healthy 62 yr old man and just had L4/5 fusion with instrumentation (screws and rods) and reduction (putting the vertebrae back into alignment), decompression of the nerve roots to clear the nerve channels, etc. I'm only 6 days out but aside from the surgical pain and anesthetic recovery (which is significant in terms of bowel function), the leg pain so far seems to be mostly gone. Maybe some pain is masked by the surgical pains I have. I had an excellent surgeon a Kaiser Oakland, and good hospital care.

So, before considering surgery, make sure you understand what kinds or surgery are success for what kinds of conditions. Fusions are not very successful for back pain, in the range of 40-60%, whereas fusion for spondy success rate is 80-85%. Do your homework and be informed.

-Ken

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