Dr. Anuj Gupta
Spine Surgery
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
What is bilateral spondylolysis between L5 and S1? What is the cause? What is the remedy? I have pain near the tail-bone, especially when seated. I have started experiencing a sharp pain when lifting clothes from a bucket.
Hi,
Welcome to icliniq.com.
Spondylolysis is basically lysis of pars interarticularis. This is the bone responsible for stability between two vertebral bodies. At your age, it is not surprising to find this because most commonly it is seen after degenerative changes. Usually, if this spondylolysis is unstable then it can cause back pain. According to you, pain is at the tail-bone and while sitting. So it could be coccydynia. Whatever it is, just maintain a healthy lifestyle. Make a habit to walk for 4 km at one stretch daily. Also, do some stretching exercises. Get IFT (interferential therapy) or SWD (short wave diathermy) in your painful area and take painkillers SOS. Most of the spondylolysis can be managed with regular general conditioning exercises. If you can tell me more about your pain. what happens to your pain when you bend forwards and then become straight? Press your tail-bone, is it painful? Does pain travel down to your leg?
Patient's Query
Thank you doctor,
Incidentally, the patient is my son aged 28 years and not me (aged 59). Does this alter any of your diagnosis or treatment? It was not caused by any accident or injury. The answers to your questions are as below (by my son):
The pain only lasts when the back is stretched. It goes away in a few seconds after straightening. For example, while bending down to wash hands, there is some pain (feels like pricking) near the tail-bone. This goes away after standing straight for a couple of seconds. There is no pain when the tail-bone is pressed. When the incident first occurred, there was a pain in the left leg for a few days, but there is no pain there now (it has been two weeks since the incident). The pain started with a twisting motion of the spine. I had bent down and pushed a heavy bucket to one side and felt a sharp pain in the back.
Given the patient's age and how the pain started, are there indications that the spondylosis will heal? The MRI report says that this is grade 1 antero-listhesis (of L5 over S1) due to bilateral spondylolysis. Also, will traction help to correct listhesis?
Hi,
Welcome back to icliniq.com.
Most of the listhesis can be healed by conservative treatment. My basic treatment is again the same. Regular walking for 4 km and when comfortable start brisk walking and running thereafter. Get an X-ray LS spine flexion and extension view which will tell that the listhesis is stable or unstable. Traction has no role for listhesis. Do not worry too much. Ask him to follow walking and exercises regularly and get an X-ray and send it to me.
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Spine Surgery
Orthopedician and Traumatology
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