What is the treatment for lytic spondylolisthesis?

Question

Hello doctor,

Two months back, when I was moving a ladder, I twisted the wrong way and injured my back. At that moment, I felt like I sprained or pulled something. Unfortunately, during the following weeks, I developed more symptoms; these include burning, numbness, weakness in the left leg, sharp shooting pain in the lower leg, hip pain or stiffness, and spasms. I did seek medical attention immediately and was sent for an MRI scan. I would like to share my images to get a second opinion. Orthopedic Dx - Radiculopathy (lumbar region) and spondylolisthesis. MRI impression - Bilateral L5 spondylolysis and 0.19 inches anterolisthesis of L5 on SI and associated degenerative disc disease and facet arthropathy producing severe bilateral L5-S1 foraminal stenosis. I received an epidural six months, which alleviated the pain, but not completely. I am currently going for PT twice a week for the past six weeks. But the results are not so appreciable. I have a constant burning sensation in my lower back. I experience pain while standing or sitting for a long time (varies between 5 to 8 on a scale of 1 to 10). Sleep has become an issue as I am constantly repositioning to get comfortable. When I get up, it pains a lot, especially the hip region. I have an appoinment with an orthopedician next week. My primary concern is getting back to work. I work in healthcare, and my job requires a lot of patient lifting. I am on my feet all day. I am very nervous because I need to work and I am afraid that the problem will worsen. I would appreciate any feedback or suggestions you can offer. Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for writing in, and I understand your concern. Does your lower back pain travel down to your leg, or is it confined to the lower back region? Kindly reply.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

I went through the reports attached.(attachments removed to protect patient's identity). After evaluating the symptoms and reports, you have lytic spondylolisthesis at L5-S1, which means there is a forward slip of L5 over S1. It has been there for a long period of time. You must be having episodes of mild to moderate back pain earlier also. Now it has manifested properly. Treatment for this depends on whether the slip is stable or unstable. It also depends on whether the patient has any relief with conservative management like medications, physiotherapy, and epidural injection, which you are already taking. To look for instability, I suggest you take another x-ray which is done in flexion and extension of the lumbar spine in lateral standing position. I hope you find the reply useful.

Regards.