spondylolisthesis - help

[meltheoneandonly]

I have been diagnosed with grade2/3 spondo between L5- S1 with narrowing of central canal and both foramina causing some compression of exiting nerve roots. Does anyone know how effective physio can be for this sort of picture.?I also have mild central posterior protrusion of the L4-5 disc. Bit traumatised so any information gratefully received.
M

[Ian]

Yes

Physio will help with
1. Education (do's and don'ts)
2. Exercises to increase stability

[Nicholas]

I'd have to say to give physio a try.

[Sydney Uni Sports Doc]

I agree with both of you.

[Mischap123]

Mel,
I also agree. Conservative therapy can often be of some help but you need to make sure the spondy is stable first. This is tested via functional x-ray views ie a comparrison of you bending forward and then arching back. If there is too much shift in these positions, it's considered unstable and depending on symptoms you may need to consult a specialist. However I've treated an unstable spondy that didn't require surgery as symptoms could be easily managed. Best of luck.

[alophysio]

Hi Mel,

Physiotherapy can definitely help. I have helped a number of people with similar symptoms and findings on scans that you describe.

The main treatment approaches (I personally use) is to look at why you developed the spondylolithesis in the first place and deal with any "motor control" issues you have, any joint restrictions you may, any muscles spasm/tightness you may have and any coordination difficulties you have when doing certain movements.

The following study forms the basis of the exercise approach that most physios probably take...it must be specific and not a general exercise programme...

O'Sullivan, P. B., G. D. Phyty, et al. (1997). "Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis." Spine 22(24): 2959-67.

STUDY DESIGN: A randomized, controlled trial, test--retest design, with a 3-, 6-, and 30-month postal questionnaire follow-up. OBJECTIVE: To determine the efficacy of a specific exercise intervention in the treatment of patients with chronic low back pain and a radiologic diagnosis of spondylolysis or spondylolisthesis. SUMMARY OF BACKGROUND DATA: A recent focus in the physiotherapy management of patients with back pain has been the specific training of muscles surrounding the spine (deep abdominal muscles and lumbar multifidus), considered to provide dynamic stability and fine control to the lumbar spine. In no study have researchers evaluated the efficacy of this intervention in a population with chronic low back pain where the anatomic stability of the spine was compromised. METHODS: Forty-four patients with this condition were assigned randomly to two treatment groups. The first group underwent a 10-week specific exercise treatment program involving the specific training of the deep abdominal muscles, with co-activation of the lumbar multifidus proximal to the pars defects. The activation of these muscles was incorporated into previously aggravating static postures and functional tasks. The control group underwent treatment as directed by their treating practitioner. RESULTS: After intervention, the specific exercise group showed a statistically significant reduction in pain intensity and functional disability levels, which was maintained at a 30-month follow-up. The control group showed no significant change in these parameters after intervention or at follow-up. SUMMARY: A "specific exercise" treatment approach appears more effective than other commonly prescribed conservative treatment programs in patients with chronically symptomatic spondylolysis or spondylolisthesis.

[Flipflop]

Hi Mel....
I have traumatic spondylolisthesis at s1/l5. I would recommend a gym ball. It is one of the best ways of strengthen your core muscles. Your physio should advise you on it. I sit on mine twice a day with very, very gentle bounce (no space hopping) I understand your worries. My spine was injured in 03, in 04 it became unstable, 05 was fine, but in May of this year it became unstable. Best not to do anything without discussing it with your physio first.
It is a very worrying time for you and wish you well.

I am not sure if it is ok to post a link on this site, if it's not then I am sure the moderators will correct me.
http://www.thephysiotherapysite.co.uk/

With kindness

[bandym]

Could anyone let me know what is worse?grade 1-2 or 3-4 .I should know by now but it hasn't played up like this for 7 odd years.oh thats L5 on s1 if that helps.:confused:

[expatient]

I would recommend a good expert who corrects your sacroiliac joints and ilium rotation. That is the reason for a spondylolisthesis. It can be corrected. I have seen few cases...

[Mischap123]

Bandym,
Grade 1 means the vertebra has slipped forward 1/4 of the length of the vertebra below. Never seen a grade 4, but grade 3 looks terrible.

[Chons]

Grade 3-4 is worse. Wishing you well.

[Chons]

I am 26 years of age and was diagnosed with grade 3 spondylolisthesis. I have many other complications with nerve compression and discs and have been told my spine resembles that of a 70 year old. Just wondering if anyone shares the same problem... I've been told that surgery is inevitable...I require my verterbra to be fused. Also, any good doctors out there? Many thanks.

[suemsm]

Hi Chons, where are you located? I 36 and currently completing an inpatient rehab program following many months of disability with L4-5 L5-S1 disc prolapse, pars defect, spondylolisthesis and nerve root compression. I was referred to a rehabilitation and pain specialist by the surgeon who will operate if the instability is not improved by mid year (unlikely, but the rehab will assist in post op recovery anyway) I am extremely impressed by the gains I am making with the rehab. I also know from working in the field that the surgeon I am seeing is 'the best' in Melbourne when it comes to spinal fusion. Happy to provide details if you are interested. Cheers :)

[richard parkinson]

Dear Mel
Grade 4 is called a spondyloptosis. It is a complete dislocation of one vertebra on another. Stability of the motion segment is definitely important but certainly people can have disabling symptoms in the absence of obvious motion segment instability. Physiotherapy can certainly help with stabilisation and improvement in core strength.
However, in cases where there is weakness in the legs, constant numbness, or (most worrying) incontinence, this usually indicates that the nerve compression has reached a critical point and permanent neurological injury is a major risk. This risk is higher the worse the grade of spondylolisthesis.
The surgery usually involves a decompression of the lumbar nerve roots, and a fusion as the segment is usually unstable to start with. Carefully selected and counselled patients almost always have an excellent long term result from the surgery and are very happy to get rid of their leg pain, which can be very severe.
I reserve surgery for the patients with disabling nerve pain or weakness which has clearly not improved or is worsening despite a trial of physiotherapy, hydrotherapy, core strength program and lumbar bracing. This is a relatively small percentage of the patients with this condition.
I would recommend that if you have this condition, particularly if you are getting leg pain, that a consultation with a neurosurgeon and an MRI of the lumbar spine are a good idea, at least to define the problem.
Richard Parkinson FRACS
Neurosurgeon
St Vincent's Clinic

[scottb721]

In 94 I was diagnosed with having a 15mm slip if L5. Xrays last week showed the same 15mm slip. What catergory would a 15mm slip be classed as?

Have been getting told of late that Pilates is the solution to being pain free. Anyone tried this ?

Thanks

[simontt]

Grade 3-4 is worse
Grade 1-2 is better