Update on my visit to the surgeon

[ga7sh]

Thanks for the input Justin.
Muscle atrophy! that doesn't sound too tempting...
I'm glad you guys are of the same opinion as myself. I'm going to get a brace today, and I'm going to reschedule the appointment in one month instead of three. I think one month is more than enough time.

To answer your question:
The MRI and CT Scans showed the same as the initial diagnosis:
grade 1 spondylolysis and spondylolithesis at the L5-S1 with mild L5 root compression, according to the doc.

I asked the doctor if the reports show how much the slippage is (it was 2cm/ .78in last time), but he said the report didn't mention the amount of slippage. This would've been a good measure of how much the condition has progressed since then, if at all.


After doing a bit of research, it sounds like the doctor was talking about posterior fusion as the surgical option, but I'm not certain.

Thanks again everyone, i'll post updates as I get them.

[Justin]

Thanks for the input Justin.
Muscle atrophy! that doesn't sound too tempting...
I'm glad you guys are of the same opinion as myself. I'm going to get a brace today, and I'm going to reschedule the appointment in one month instead of three. I think one month is more than enough time.

Ghaith, I want to stress that what I posted above is not medical advice and is not intended for you to change or stop the care recommended by your treating physician(s).

Your plan about scheduling a follow-up appointment after one month sounds reasonable and at that point you can assess your progress with your surgeon. I want to point out that bracing has been successful in treating low-grade spondylolithesis (Grade I & II):

Treatment of symptomatic spondylolysis and spondylolisthesis with the modified Boston brace.

Steiner ME. Micheli LJ. Spine. 10(10):937-43, 1985 Dec.

Sixty-seven persons with symptomatic spondylolysis or grade 1 spondylolisthesis were treated with the modified Boston brace. The average age was 16.0 years, and the average follow-up was 2.5 years. Following treatment, 52 persons (78%) had either an excellent or good result with no pain and returned to full activities. Nine (13%) continued to have mild symptoms, and six (9%) subsequently required fusion in situ. Twelve of the patients showed radiographic evidence of healing of their pars defect(s). This group and those with the best overall results tended to be men with spondylolysis and relatively acute onset of symptoms. Age, delay in treatment, spina bifida, and bone scan result did not correlate with the ultimate clinical result.

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Brace treatment for symptomatic spondylolisthesis

Bell-DF; Ehrlich-MG; Zaleske-DJ Department of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Canada. Clin-Orthop. 1988 Nov(236): 192-8

The literature documents progression of spondylolisthesis, most commonly during the adolescent growth spurt. Twenty-eight patients with Grades I and II spondylolisthesis were treated with antilordotic braces. Presenting signs and symptoms included back pain (61%), tight hamstrings (53%), increased lordosis (25%), and mild scoliosis (21%). Three patients presented with spondylolysis and progressed to a slip prior to initiation of brace treatment. Mean duration of brace treatment was 25 months. In the brace, lateral roentgenograms demonstrated a significant reduction of lumbar lordosis and sacral inclination. At the conclusion of brace treatment all patients were pain-free and none had demonstrated a significant increase in slip percent.

To answer your question:
The MRI and CT Scans showed the same as the initial diagnosis:
grade 1 spondylolysis and spondylolithesis at the L5-S1 with mild L5 root compression, according to the doc.

I asked the doctor if the reports show how much the slippage is (it was 2cm/ .78in last time), but he said the report didn't mention the amount of slippage. This would've been a good measure of how much the condition has progressed since then, if at all.

The slip degree can be measured on most lateral films. I agree it would have been nice to have the slip degree spelled out on the study reports for your reference.

After doing a bit of research, it sounds like the doctor was talking about posterior fusion as the surgical option, but I'm not certain.

Thanks again everyone, i'll post updates as I get them.

Keep us posted :thumpup:...there are many great abstracts regarding fusion and low-grade spondylolisthesis (a quick Google search will pull up a lot of good reading). Here's one...

________________________

The Spine Journal, Volume 6, Issue 6, Pages 606-614

Surgical treatment for unstable low-grade isthmic spondylolisthesis in adults: a prospective controlled study of posterior instrumented fusion compared with combined anterior-posterior fusion

J. Swan, E. Hurwitz, F. Malek, E. van den Haak, I. Cheng, T. Alamin, E. Carragee

Background context
The surgical treatment for low-grade isthmic spondylolisthesis in adults with intractable lumbar pain is usually spinal fusion. It has been postulated that anterior column reconstruction may be relatively advantageous in those patients with unstable slips.

Purpose
To compare the early and medium term treatment efficacy of two common fusion techniques in isthmic spondylolisthesis.

Study design/setting
Prospective controlled trial comparing single-level posterior-lateral instrumented fusion with combined anterior and posterior-lateral instrumented fusion in sequential matched cohorts of patients with radiographically unstable isthmic spondylolisthesis.

Outcome measures
Primary outcome measure of success was an Oswestry Disability Index (ODI)≤20. Secondary outcome measures included patient determined minimum-acceptable outcome on four questionnaires: pain intensity (visual analog scale), ODI, medication intake, and work status. Radiographic outcome of fusion was determined by radiographic union and motion on flexion/extension X-rays. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated for primary outcome of success for combined fusion compared with posterior fusion.

Methods
The study was conducted over a 6-year period. The first cohort of 50 consecutive patients was treated with a single-level instrumented posterior-lateral fusion; the second sequential cohort was treated with an anterior interbody fusion and the same posterior operation. Observations were made at baseline, 6 months, 1 year, and 2 years after surgery. Final radiographic assessment was made at 2 years after surgery.

Results
Baseline demographic and clinical factors were well-matched in the two cohorts. At 2 years, 46 posterior-only fusion subjects and 47 combined fusion subjects completed the full follow-up regimen. Outcomes were better by all measures at 6 months and 12 months in the anterior-posterior cohort. Comparing the primary outcome measure (ODI outcome≤20) in the posterior versus the combined groups, success was achieved at 6 months in 11 versus 30 (RR=2.67, 95% CI 1.53, 4.67; p=.0001); at 1 year, 20 versus 34 (RR=1.66, 95% CI 1.14, 2.42; p<.005); and at 2 years, 29 versus 36 subjects (RR=1.21, 95% CI 0.93, 1.59; p=.14). At 6 months, 13 posterior-only and 25 combined group subjects had returned to work (RR 1.88, 95% CI 1.10, 3.21; p=.01). More patients achieved their preoperatively determined minimum-acceptable outcome at each time point. There were three nonunions in the posterior-alone cohort and one in the combined group. Serious complications and reoperations were similar in both groups.

Conclusion
Outcomes up to 2 years were superior by clinically important differences after a combined anterior-posterior operation compared with posterior-alone surgery for unstable spondylolisthesis; however, between-group differences attenuated appreciably after 6 months. The apparent clinical and occupational benefits of combined fusion should be considered along with possible increases in minor complications and procedure-related costs.