How can I manage pain from grade 1 spondylolisthesis?

Question

Hi doctor,

I have constant low back pain. The pain is radiating from the lower back to the buttocks and both legs. There is a tingling sensation after exercise and walking. Before five years, I had a bad episode of back pain with sciatica. I was told that it was a slipped disc but did not get a scan. Since then I have had odd flare-ups, but nothing serious until a month ago. Now, I was diagnosed to have a high grade 1 spondylolisthesis, and the disc as that level is almost gone.

It means the bones started to fuse, although there seems to be a small gap on the scan. I was told that it would be better to let it self-fuse instead of having an operation. The exiting nerve roots are narrowed at this level, but no problem with the spinal canal itself.

I was wondering how long would take for the vertebra to self-fuse?
Are there any disadvantages or future problems?

I am in constant pain, and my quality of life is not great because of this issue. I have tried myself keeping active, but too much activity make the pain worse. I am a police officer, and unable to do any front line duties. I am only doing desk-based work, and I have to change my position frequently as this also hurts. I am currently on Tramadol and Co-codamol.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

Regarding the time required for fusion, it is highly variable and thus tough to say. I need to explain here that this process is usually a very slow one and occurs irregularly. For example, it can proceed 5 % for a month and then stop. After a couple of days or months, it will complete another 18 % to 20 % and so on till completion. Therefore, putting a timeline is difficult. There are a few things you need to know about this process.

It will happen when the bones start touching one on the other. It causes the surfaces of both bones to fracture a little bit from one side, let us say left, and then the body heals it. Again these bones fracture at another site this time right, and the body heals it. So, this is a slow and painful process of fracturing and healing. If it happens fast, it will be more painful.

The advantages of this process are as follows:

It is a natural process, and because of that it preserves more functionality and some flexibility of the spine, rather than to stick a metal implant to fix the vertebra.
This process is free of (though not completely) the possible nerve injury during surgery, which can result in bowel and bladder control being lost or weakened. Also, the leg muscles can have their strength decreased.
You will retain the option of surgery if there is any involvement of the bladder and bowel control.

The disadvantage of this process is slow and unpredictable.

1. Your imaging shows that the bones are pretty much close and the start of fusion process is just about there. Other than manageable pain, you do not have any other symptoms.

2. I understand that it would be difficult on a day to day basis, but that might be better than going for surgery. As surgery is not going to be painless and post-surgical pain may persist for a couple of months. Also, your spine appears stable. So, immediate surgery might not be required for mechanical stability.

3. Your doctor has advised you the best already. In the case of any severe pain, weakness in legs and decreased control of holding stool or urine, consult your doctor immediately.

4. Building core body muscles and weight reduction (if your BMI is more than 25) can help. This is to be done only under the supervision of your treating doctor.

I hope this helps.

Thank you.