Spondylolisthesis

[Rob]

Hi Jack,

It's a bit difficult for me to know how I'm doing as I don't have anything to compare it too. My surgery was 3-weeks ago yesterday. My first formal post surgery appointment is May 4th, ~7-weeks after surgery.

The incisions look good and I haven't had any leakage since maybe the first of second day at home, albeit really minimal, over two weeks ago.

The only therapy related activity I was given was to walk. They didn't quantify how long or far I should be walking. I’m currently walking 20-25 minutes three times a day. I also go up and down the stairs in our house several times a day as my office and the bedroom are upstairs.

They told me I could drive when I'm comfortable to do so. So far I’ve been a passenger in the car several times, going to the grocery store or shopping and occasionally out to eat. I haven’t driven yet, as I haven’t had to, but likely could.

They didn't give me any direction on when to try and wean off of the meds. I kind of assumed they were going to let it ride until I run through the prescription or go in for my 7-week appointment. I’m still taking Hydrocodone (10/325) every 4-hours. In addition to that I take one ambian at night to help me sleep.

The pain is relatively minimal most of the time, more discomfort than pain. However every once in a while, last night for example, it reaches the limit of uncomfortable and into the realm of pain. I took two Hydrocodone's at 4:30A this morning.

What are your withdrawal symptoms like (i.e. chills, cramps, mood swings, ...)?

Regards,


Rob

[Jack-of-all-trades]

Hi Jack,

It's a bit difficult for me to know how I'm doing as I don't have anything to compare it too. My surgery was 3-weeks ago yesterday. My first formal post surgery appointment is May 4th, ~7-weeks after surgery.

The incisions look good and I haven't had any leakage since maybe the first of second day at home, albeit really minimal, over two weeks ago.

The only therapy related activity I was given was to walk. They didn't quantify how long or far I should be walking. I’m currently walking 20-25 minutes three times a day. I also go up and down the stairs in our house several times a day as my office and the bedroom are upstairs.

They told me I could drive when I'm comfortable to do so. So far I’ve been a passenger in the car several times, going to the grocery store or shopping and occasionally out to eat. I haven’t driven yet, as I haven’t had to, but likely could.

They didn't give me any direction on when to try and wean off of the meds. I kind of assumed they were going to let it ride until I run through the prescription or go in for my 7-week appointment. I’m still taking Hydrocodone (10/325) every 4-hours. In addition to that I take one ambian at night to help me sleep.

The pain is relatively minimal most of the time, more discomfort than pain. However every once in a while, last night for example, it reaches the limit of uncomfortable and into the realm of pain. I took two Hydrocodone's at 4:30A this morning.

What are your withdrawal symptoms like (i.e. chills, cramps, mood swings, ...)?

Regards,


Rob

Walking is suppose to be the best way to rehab, or at least that is what my surgeon said. I was limited to picking up 11 lbs for the first month, then 11-20 lbs until now. I have been able to use my other hand and arm, feet, knees to pick up stuff that bypasses my back. I have 7 sets of these pickup pincher devices scattered around my house to aid in getting stuff off the floor. Sometimes it seems like the distance between my knees and the floor is an awfully long ways. Twisting at the waist is not recommended.

As far as withdrawals is concerned, it seems to be related to length of time and dose. If you have only been on Low to mid dose Vicodin 10/325 (3-6 a day), withdrawal will be kind of like the flu for a few weeks. The first week you probably won't want to work, as with the flu.

[Carmen]

This sounds like my situation. Fusion at any given level is kind of the supposed cure-all. The basic surgery is over 50 years old but has been refined over the years. Any slip of grade one or less without a pars interarticularis defect (fracture of the thin bones on either side of the spinal cord) might be a candidate for disc replacement. Disc replacement is kind of the new kid on the block and has still not gotten universal acceptance in the USA.

I ended up going with a minimally invasive posterior lumbar fusion with internal fixation of L5 on S1. Of all the lumbar levels, this one seems to be the most appropriate for fusion opposed to ADR. Posterior is a little better than anterior, especially if you are a guy. Less risk of nerve damage.

Hi Jack-of-all-trades,
I know we have communicated before but it seems like I am about to have the same operation only in a lateral position with a minimally invasive fusion. Then they are going to turn me over and do some kind of something in the back. i still have to get a better handle on it all.
Now I am trying to get over a mylogram when they insert a huge amount of dye in an already hurting spine. No meds for home only a valium before they did it. They told me to ice it. I want to ice them. The nurses were all very nice. Anyway, any kind of information would be appreciated. Thanks, Carmen

[Carmen]

Has or is anyone getting a level fused due to spondylolisthesis and if so what grade is your slippage?

See my post to Jack-of-all-trades.

[Jack-of-all-trades]

Carmen,

My L5-S1 was a grade I spondy, with pars defect and facet disease. I can link you an actual surgery showing what this particular neurosurgeon does. Mostly a grade I spondy is no necessarily a contraindication for ADR. A pars defect, which is common with spondy is a contraindication. Generally, mild facet dz is ok for ADR moderate/severe is not.

[Carmen]

I am in the process of having a MIS TLIF done on my L5-S1. I have spondylolisthesis due to 2 breaks in my L5. The breaks have caused my L5 to slip forward 3mm.
I injured my back in April 2009 at work and have been through numerous doctors before I finally found one that was willing to treat me. I saw an Orthopedic Surgeon back on Dec. 14th. He saw the breaks right away and ordered an Xray. The Xray showed the slip in my L5. I have been waiting for W/C to approve my fusion and have gotten worse because of it.

My surgeon feels very confident that my fusion will be a success because of my age and physical fitness. I will be 21 April 25th. I used to ride and train horses and was considered a gym "junkie" Other than my breaks and slip, my spine is in very good health. Im hoping that I will be able to ride and train horses once I recover from my fusion

Hi Dodgegirl,
I am suppose to have a MIS XLIF. My surgery is suppose to be done laterally and then they turn me over and do something else, although I am not sure what. The doctor said he would not do anything with me unless I first have a mylogram. I found that to be very painful. I had anesthesia but when that wore off I was in trouble. I then had a CT scan which was nothing. The doctor does not believe in heavy duty pain meds, especially just after a procedure. He does not seem sensitive to individual differences. Another gal that I know that had surgery by him said he only gives you, and this is spelled wrong since I can't find it anywhere, but if any one knows anything about it please let me know. It is something like norcor or something similar, or nocor, etc. It is a combination of those letters. So far he has not seen anything but the X-ray. I did not have the MRI then although I do have it now. The new bit of information is there is a clinical trail that I am going to look into to. I seem to fit the criteria. The difference between you and I Dodgegirl, is that I do not have age going for me. When are you scheduled for your surgery? I wish you good luck and I am sure
it will be very successful. I will be looking forward to your posts. Carmen

[Jack-of-all-trades]

I am in the process of having a MIS TLIF done on my L5-S1. I have spondylolisthesis due to 2 breaks in my L5. The breaks have caused my L5 to slip forward 3mm.
I injured my back in April 2009 at work and have been through numerous doctors before I finally found one that was willing to treat me. I saw an Orthopedic Surgeon back on Dec. 14th. He saw the breaks right away and ordered an Xray. The Xray showed the slip in my L5. I have been waiting for W/C to approve my fusion and have gotten worse because of it.

My surgeon feels very confident that my fusion will be a success because of my age and physical fitness. I will be 21 April 25th. I used to ride and train horses and was considered a gym "junkie" Other than my breaks and slip, my spine is in very good health. Im hoping that I will be able to ride and train horses once I recover from my fusion

This sounds like the same problem I had before my fusion. One reason WC may be giving you a hard time is that 95% of the time this type of fracture, if it involves the thin bone on either side of the spinal cord called the pars interarticularis, also known as the spinal isthmus, called a pars defect by most radiologist, is not caused by injury someone gets as an adult but early in life. Say 6-12 years old. Some are even congenital. As time goes by and we get older, the ligaments around the disc space begin to get weaker. The disc looses some of its elasticity and either shrinks or ruptures. The facet joints hold the back half of the vertebra from slipping forward and due to the added strain on them develop arthritis at some point. The front half of the vertebra slip forward pulling apart at the weakest part, the pars interarticularis. Depending on what type of gym work you did could have agravated the problem too. Deadlifts, and squats, especially if you were pushing the envelope on weight could really do a number on your L5-S1. Ligament strength can't be strengthen much by exercise.

Injuries are more of a symptom of the defect and not the cause. I suspect the WC docs know this. The prior surgeons may not have wanted to do anything much without getting prior approval as they may not get paid. However, don't give up as in most states the burden of proof is in your favor.

You can research further by Googling 'Isthmic spondylolisthesis'.

[Carmen]

Carmen,

My L5-S1 was a grade I spondy, with pars defect and facet disease. I can link you an actual surgery showing what this particular neurosurgeon does. Mostly a grade I spondy is no necessarily a contraindication for ADR. A pars defect, which is common with spondy is a contraindication. Generally, mild facet dz is ok for ADR moderate/severe is not.

Hi,
i would like to see the video. How come you know so much about everything?. I he. I have seem some video's on You Tube but not as of late. So you think I could have injured it in some way. I have been divorced a long time and do most of the work myself. I am not over weight so it can't be that. This is what the myilogram showed.

This is what the myelogram showed: Tested April 7, 2010

. Multilevel degenerative change

. Complete obliteration of the L5 to S1 disk

. L4 and L5 there is a pronounced rotatory subluxation component

. Rotoscoliosis of the lumber spine with marked multilevel degenerate change

. Central canal is most compromised at L2 to L3 due to disk herniation

. Multiple levels of lateralizing degenerative change resulting in neural foraminal narrowing.

Give it to me straight. Carmen

[Jack-of-all-trades]

Hi,
i would like to see the video. How come you know so much about everything?. I he. I have seem some video's on You Tube but not as of late. So you think I could have injured it in some way. I have been divorced a long time and do most of the work myself. I am not over weight so it can't be that. This is what the myilogram showed.

This is what the myelogram showed: Tested April 7, 2010

. A Multilevel degenerative change

. B Complete obliteration of the L5 to S1 disk

. C L4 and L5 there is a pronounced rotatory subluxation component

. D Rotoscoliosis of the lumber spine with marked multilevel degenerate change

. E Central canal is most compromised at L2 to L3 due to disk herniation

. F Multiple levels of lateralizing degenerative change resulting in neural foraminal narrowing.

Give it to me straight. Carmen

Don't take what I say as gospel, in fact if anyone else can interpret as well chime in.

Several of the statements probably indicate the same underlying condition, i.e. degenerative changes. Degenerative changes are most commonly associated with age changes and less common to an old injury. Your L-spine is like it is 80 years old, (A,B,C,D,E,F). B,E,F are the most likely to be the trouble spots though any or all could be. E the central canal is the big hole where either the spinal cord or the cauda equina (bundle of nerves at the end of the spinal cord) go through. In most people the actual cord ends at about L1. Pressure here can cause pain L1-L2. F is where the nerves branch off the spine. The foramina is the hole the nerves go through.

This seems like your "Thorn of the flesh", so to speak in biblical terms, but I have a neighbor who was a neurosurgeon before he had to quit due to his lumbar spine. He now has had surgery on all Lumbar areas and is doing well pain wise. He now has a poker spine (all lumbar areas fused) but is happy with it.

[Gilbert P]

Hi Guys

looks like I fit in this category with Carmen multi level issues

Waiting for replies from Dr Zigler and Dr Delamarter.

Gil