Spondylolisthesis

[Carmen]

Hi Carmen,

The titanium rods and screws should provide more support and stability for the work that will be done on your spine, which will allow you more mobility than if they weren’t there, since they would want you to be much less mobile due to the much greater possibility of something moving.

As I may have previously mentioned I have a soft brace. It’s an Ossur ‘Miami’ lumber belt - http://www.ossur.com/lisalib/getfile.aspx?itemid=17804. I believe if I didn’t have the rods and screws I would have been in a hard shell brace.

FYI, my older brother had a L4/L5/S1 spinal fusion (posterior) approximately 8 years ago due to spondylolithesis. His surgeon was done by a surgeon at Illinois Bone & Joint (Evanston Hospital?). They harvested bone from his hip, used rods & screws and gave him a hard shell brace. I believe the BMP bone growth material and the soft shell braces were developed, or at least used more extensively, some time between his surgery and today. He noted that the pain from the surgery in and around the bone harvest site was worse than the pain in or around his spine!

Regards,

Rob

Hi Rob,

Both you and your brother picked out great doctors and hospitals. They both were in the 50 top doctors and hospitals in the US. I downloaded a lot of the material from Emory Hospital. Thanks for sharing.

I will try and answer some of your questions. I am not having two fusions. Only one will be minimally invasive, the XLIF. The other will be done traditionally in order to stabilize the spine by adding the pedicle screws and the metal rods. This will be the Laminectomy done posterior. Since the surgery is 12 hours long with positioning, it was divided up like I discussed with you before. Dr. Phillips will be following nuvasive using the BPF.
I am not sure how big the incision will be for the traditional approach. The doctor will use something left over from the laminectomy for the bone graft. He will not use anything from my hip. It sounded like this bone graft was used from throw away materials from the laminectomy. I will have to listen to the digital recorder to see if he mentioned anything regarding the L5 to S1 or L4/L5/S1. I also have to ask him about the 360. I know the other doctor was going to do that since he mentioned it to me. The other doctor only completed 8 XLIF's compared to Phillips over 50+.

Thank you so much for the work you did on researching and posting regarding Dr. Frank Phillips. I hope I made the right decision. The doctor that had not called finally called from Northwest Memorial. He is an excellent doctor but also a little effected with himself, but that is okay. He was a little taken back when I said I had already set an surgery date with another doctor. When I told him his name he said you better find out how many
scoliosis operations he has done. It may be "sour grapes." I will talk to his nurse about it when she calls tomorrow. Thanks for your questions. They will be very useful to me. You are certainly a prince. Thank you again, Carmen :thumpup:

[Rob]

Hi Carman,

Thanks but no real prince, just empathetic having been through it!:^) I know the feeling and thoughts I went through and I’m sure there’s a certain amount of commonality to those feelings and thoughts with most people going through similar procedures or events.

It seems like you’re in good hands. With the XLIF you won’t have the 4” abdominal scar I have! They also won’t need to have a vascular surgeon in the OR, which was required for the anterior approach.

FYI the incisions on my back are ~2” each and there are two of them parallel to each other, one on the left and one on the right on my lower back.

I looked up the NuVasive XLIF procedure. The following web site had an animation video of the procedure: http://www.nuvasive.com/patients/revolutionary-approach.htm.

It sounds like you recorded your meeting with your doctor, that’s a great idea! I try to take notes but sometimes I read the notes and there are too many fragments as well as missing information to make sence.

Out of curiosity, what web site did you look at for hospital ratings?

Regards,

Rob

[Katie]

Can someone explain how spondylolisthesis is graded? Mastermind said his was one percent and christytaf said hers was a four. Until the surgeon actually got in there and saw what was going on, I didn't know I had any slippage even after three MRIs. Over half a dozen surgeons who reviewed my images missed it. How is that possible?

The surgeon who caught it just said it was' significant' and commented that it should have been enough to warrant surgery even here in Canada where they wouldn't operate 'just for pain'. As if that isn't enough.

Carmen, did you remember what question you wanted to ask me?

[Justin]

Can someone explain how spondylolisthesis is graded? Mastermind said his was one percent and christytaf said hers was a four. Until the surgeon actually got in there and saw what was going on, I didn't know I had any slippage even after three MRIs. Over half a dozen surgeons who reviewed my images missed it. How is that possible?

The surgeon who caught it just said it was' significant' and commented that it should have been enough to warrant surgery even here in Canada where they wouldn't operate 'just for pain'. As if that isn't enough.

Carmen, did you remember what question you wanted to ask me?

From the Spine Patient Society Educational Materials:

A condition called spondylolysis can lead to the slippage that happens with spondylolisthesis. Spondylolysis is a defect in the bony ring of the spinal column. It affects the pars interarticularis, mentioned earlier. This defect is most commonly thought to be a stress fracture that happens from repeated strains on the bony ring. Participants in gymnastics and football commonly suffer these strains. Spondylolysis can lead to the spine slippage when a fracture occurs on both sides of the bony ring. This slippage is called spondylolisthesis. The slippage is graded from I through IV, one being mild, IV often causing neurological symptoms. (Click here). The back section of the bony ring separates from the main vertebral body, so the injured vertebra is no longer connected by bone to the one below it. In this situation, the facet joints can't provide their normal support. The vertebra on top is then free to slip forward over the one below.

A Patient's Guide to Lumbar Spondylolisthesis

[Rob]

Hi Katie,

I agree with you, it’s quite amazing that a ½ dozen surgeons didn’t see it! Picking up on Justin's thread, the definition below is copied from the link http://www.scoliosisassociates.com/subject.php?pn=spondylolisthesis-014:

“In general, physicians use the Meyerding Grading System for classifying slips. This is a relatively easy to understand system. Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below. Thus a Grade I slip indicates that 1-24% of the vertebral body has slipped forward over the body below. Grade II indicates a 25-49% slip. Grade III indicates a 50-74% slip and Grade IV indicates a 75%-99% slip. If the body completely slips off the body below it is classified as a Grade V slip, known as spondyloptosis.”

A plain x-ray can be used to grade the slippage. I had a grade 2 spondylolisthesis (~30% slippage). Mastermind’s must have been a grade 1 and Christytaf’s a grade 4, as opposed to 1% or 4%.

As I recall reading in “…went MIA…” you had a two level fusion in mid-march. I’m sure the milk allergy you noted was scary and the last thing you needed!!! I had a two level anterior / posterior fusion (L4/L5/S1) on March 15th.

How are you feeling now?
Are you still on pain meds?
Did you had a 6-week follow-up?

Regards,

Rob

[Katie]

Justin and Rob, thanks so very much for the explanations. By the descriptions given, I suspect I had a class 2 slippage. That would probably cause a lot of nerve compression, would it not?

I feel like I've crossed a threshold now. I'm feeling so much better since I eliminated the milk, with more energy and much less over all pain throughout my body. My pain levels in the area of my fusions has decreased over the past few days as well. I'm sleeping through the night with few exceptions and waking with little if any pain. I think I was down to 60 mg of morphine over the past 24 hrs. Most days I'm at 80-100 mg, down from over 300 mg pre-surgery.

Two days ago though, I did a series of stupid things which raised my pain levels substantially. Sitting too long and also in a bad position, etc. were probably the culprits. When friends come over and don't take my condition into consideration, I tend to overdo it, trying to be polite, but that has to end. I had a very hard time sleeping that night, as even lying down hurt instead of relieving the pain.

My appetite has come back with a vengeance too Not sure if that's a good thing or not Up till the past week, I've had little if any urge to eat. My taste buds had disappeared and the thought of food almost made me ill. Now I'm at the fridge every hour or so. And for the first time in several years, the constipation is gone It probably has a lot to do with the reduction in morphine, but I've been down substantially since the surgery. I'm not sure what took so long, but I'll just celebrate this little piece of joy anyway. I sound like I belong in an old folks' home where everyone sits around discussing bodily functions!

No, I haven't had a six-week check-up. Unfortunately I don't have a surgeon here who would treat me, so I have to send my three month and onward images back to Brazil for evaluation. I'm really hoping nothing bad has happened before that, as things should be well set by then.

What happens if the cage has moved in that time? Has anyone encountered that (other than the ADRs that subsided on one of our posters a year or so ago)? Not borrowing or expecting trouble, but just curious...can the fusion then be readjusted somehow? My only concern is that I don't have any extra stabilization in place, no rods or screws, etc. because of my metal allergies. The cages are just sitting between the vertebrae with the 'bone mash' and growth medium inside, waiting for everything to mesh.

Rob, how are you doing with your pain meds and check-up?

[Rob]

Hi Katie,

Really glad to hear your doing better, appetite back, constipation going away and able to reduce your meds! Don’t worry about the old people thing, it makes us all understand them better. Of course I’m closer to them than you!!!

I think the 1-4 grading system is more quantitative than qualitative. In other words it’s simply a measurement of how far forward it’s slipped, as opposed to the symptoms resulting from the slippage. In my case they were a little surprised that I never had any sciatica pain. However, the same amount of slippage on someone else may have generated more or less pain. The link I sent noted: “Patients with spondylolisthesis, …children or adults may present with back and/or leg pain, urinary incontinence or frequency, or may have little or no symptoms at all. …Some people with spondylolisthesis are symptom free and only discover the disorder when seeing a doctor for another health problem.“

Though I don’t know I would assume if your spine becomes unaligned or the cage moves they would have to make a decision that the movement is okay, to the extent it moved, or to go back in to make adjustments. I’m sure it would be better to find that out now as opposed to after the new growth meets the existing bone and begins to fuse. I was told by my surgeon that the fusion should become ‘sticky’ (his word), where the new growth meets the existing bone, somewhere between 3-4 ½ months post surgery.

I had my 6-week post-op check-up two weeks ago today (4-29). Hey took a standard x-ray and confirmed that ‘all the hardware is in place and looks good'. They said it’s ‘too early to see any bone growth’, and that bone growth should be visible on the 12-week post-up check-up where they’ll take a CAT scan.

The PA was annoyingly surprised that I had still been taking the 7.5 Hydrocodone's every 4-hours (7 per day). He repeatedly lectured me on the fact that it's time to get off of them. Of course he’s never had spinal surgery! I’m now down to four hydrocodone's (7.5mg hydrocodone/325mg acetiminiphen) per day. However I didn’t go through the years of mega pain you did. I always had pain but was able to deal with it using Ibuprofen, or at least bring it to a level where I could tolerate it.

I’m sure the reduction in constipation is a result of reducing the meds, as I definitely experience a significant reduction in it. I was using Metamucil prior to reducing the meds. Now, no problem!:^)

I’m taking three walks per day for a total of a little over 1 ½ miles (10-12 minutes / walk). I was walking 2 ½ - 3 miles per day but got lectured by the PA that I was walking too much. I think he was right as my pain has reduced since I reduced the distance.

My anterior incision area is relatively pain free with an exceptional twinge every once in a while if I slightly turn in what is apparently a bad direction. I have some posterior discomfort / pain which I believe is the interface between the healing muscle tissue and the hardware (screws & rods). I also get some small muscle spasms around the same area. The surgeon’s office says it’s normal.

I have a secondary unrelated pain issue in my right shoulder. On 4/20 I was diagnosed with 'frozen shoulder syndrome' by a shoulder surgeon. This is where in the sheathing around your tendons and muscles stick and prevent you from moving your arm / shoulder. The pain can be extremely acute. I’m going through PT now. They say once it’s successfully treated you’ll likely never get it again.

Between my back and shoulder I sleep in 1-hour increments. I get out of bed once or twice a night and sit in a chair for a while, up to an hour. Good thing I nothing to do during the day!!!

Out of curiosity why did you go to Brazil for your surgery? Can’t you now go to a local orthopedic for the post surgical follow-up?

Regards,

Rob

[Katie]

"Out of curiosity why did you go to Brazil for your surgery? Can’t you now go to a local orthopedic for the post surgical follow-up?"

Rob, after several years of going through local surgeons who would not touch me, as "pain is not a reason for surgery", and the cervical surgery was judged to be 'too dangerous', I finally found a surgeon in another province who was willing to do surgery on me late last fall. Just before booking it, I found out that I was severely allergic to any and all metal appliances they would use in me.

I started searching all over the world for someone who would be able to help, who had a non-metal appliance. The only one I could find was this surgeon in Brazil, Dr. Pimenta. He also works closely with Nuvasive in the US, traveling back and forth. He was able to come up with the silicone artificial disc for my neck, and used the PEEK cage for my lumbar fusion. There was a ceramic ADR also, but he chose not to use it for me. On top of having the devices, he was also half the price of going to Germany or others overseas, so I could afford it. It came together very quickly.

As for going to a local orthopedic surgeon....well, I was told that if I went out of country for surgery, no one would want to look at me. I suppose I could go to the emergency department for images, but they may choose to just send me home as it doesn't fall under an emergency. I would like to see a highly regarded ortho in a nearby community that Pixie on here recommended, but I have to have a referral first...not easy, and there is a nine month waiting period to get in, if he will see me.

I can get my pain specialist to order the images for me as she has ordered all my MRIs, and then I will send them to Brazil for assessment...it's the best I can do with our system. If I had a working relationship with my family doctor, she may do it too, but she was such a hinderance in my fight to find help that I haven't even told her that I had surgery.

I've got to follow your lead and put more miles on. It sure makes my back flare though.

Congratulations on your progress! (I feel like a bit of a slacker )

***There's a reason I haven't put my age on here...let's just say that I was about your age when my back problems started in earnest ;-) ****

[Carmen]

Hi Carmen,

I hope you cought the thread from 'Jack of all trades' regarding 'Dolotin'. I'm not sure where I picked up that spelling (my pain meds, the internet, ...???) but I meant to say Dilaudid (hydromorphone).

Sorry about that...

Regards,

Rob

Thanks Rob, I just changed it in my notes. Carmen

[rockinit]

Hello-

First post, I apologize in advance for my ignorance.

So I am trying to figure out how to be pain free. Just recently started to get real serious about it as I believed I was just being a whiner.

I have pretty much seen that everyone has had surgery for this condition, even at Grade 1. I really don't want to have surgery. I am trying chiropractic, PT, cortisone, and nothing is working. I have only been doing this since May. Should I be patient and get use to not sleeping? My doctor is supposed to be a specialist but he is always rush jobbing me, if he even shows up (nurse practitioner instead). Should I keep on this path of trying to recover? Or is surgery the only way to cure the pain