Spondylolysis and Spondylolisthesis

L. David Roper
http://arts.bev.net/roperldavid/
January 2008

Around the year 2000 or earlier I started having numbness on the outside of my left thigh and my left buttock. Gradually it traveled down the leg and often a severe tingling pain would accompany it when standing for a long time or sitting for a long time.

I saw a chiropractor in 2001 and had an x-ray taken of my lower spine. I saw a neurologist in May 2003 and had an MRI of my lower spine. The diagnosis was that I have bilateral spondylolysis at the L5 vertebra (the lowest vertebra on the spine) with mild spondylolisthesis. The L5 vertebra has slipped forward on the sacrum.

Definitions:

Spondylolysis: Dissolution of a vertebra, especially the pars interarticularis.
Spondylolisthesis: Forward movement of one building block of the spine (vertebra) in relation to an adjacent vertebra.
pars interarticularis: The segment of bone between the superior and inferior articular facets, especially in the lumbar spine.

Lumbar vertebrae:

Patient's Guide to Lumbar Spondylolysis:

Patient's Guide to Lumbar Spondylolisthesis:

Notice how L5 has slipped forward, which can pinch nerves leading to the legs and to the bladder and rectum.

Possible causes:

My spondylolysis may have been caused by playing basketball in high school or by shoveling much wheat and throwing bales of hay up on trucks or by a minor tractor accident in my teens.
I fell on a stairway in May 2006 and broke the end off of my left bottom rib. I wonder if that caused the spondylolisthesis to worsen.
I have fallen a few times on slippery ground over the last several years, which may have caused the spondylolisthesis to worsen.

The documents listed above describe my symptoms very closely:

"numbness, tingling, slowed reflexes, and muscle weakness in the lower body" Over the last several years the numbness and tingling has traveled down the left leg and now is accompanied by pain in the knee and the back of the calf. The tingling has crossed over the right buttock into the upper part of the right leg now. I recently had an x-ray of the left knee and was told that I probably will never have to have a knee replacement and that the pain in it was due to inflammation. I believe that the nerve problem has passed through the knee and now occasionally shows up in the calf.
"can affect the nerves that go to the bladder and rectum" About a year ago I had a colonoscopy because of unusual bowel movements; it showed no problems inside the colon. Recently the bowel movements and urination have become frequent and the feces are usually small or slender. Much flatus occurs. (I have had urinary infections in the past, but the recent frequent urination is not accompanied by infection.

Symptoms:

The numbness and pain has progressively worked its way down the left leg into and past the knee. It has also gone all across the buttocks and down the right leg just above the knee, but much less severe on the right.
I have great difficulty sitting down on the floor and especially getting back up, because of pain in the left knee and lower back.
When I bend over my lower back aches, especially when I straighten back up.
When I sit for a long time my lower back aches, but not as bad as the buttocks.
I occasionally have slight pain in the lower back when not bending over, but not often.
When I wake up in the morning either my left knee is aching if I had been sleeping on the right side or one or both buttocks are aching if I had been sleeping on my back. I generally do not sleep on the left side because of the weak pain it causes on the left buttock and leg.
My left leg is puffier and wider than the right leg, possibly because of the inflammation caused by the pinched nerve.
Both calf muscles tend to cramp right after I wake up in the middle of the night or in the morning; I can usually forestall it by rapidly flexing the legs. The cramping is much less when the pain in the left leg is high. My guess is that the pain causes me to move the leg while sleeping, preventing the cramping.
Recently I cannot get to sleep on my back and both sides because of mild stinging pain; I have to sleep on my stomach.

Several years ago I bought memory-foam pads for all seats and beds that I use at home and in my car, because of the pain in the buttocks. Sometimes I take a pad with me when I know I am going to have to sit for long periods. Now they help, but do not completely relieve the pain when sitting, especially for the left buttock.

On 19 January 2008 the knee and thigh pain got so bad that I had trouble walking and doing stairs. I wore a knee brace for two days.

Ibuprofen to Relieve Pain:

It was suggested that I might want to take ibuprofen to quell the inflammation in the left knee. I started taking 400 mg in the morning and in the evening. About a week later I had about two days of complete colon elimination with no discomfort or pain, so I quit taking the ibuprofen. A few weeks later I started taking 200 mg of ibuprofen in the morning and in the evening. After about 2 weeks I quit taking it because it did not seem to help the knee pain. Then the knee pain got much worse, so I started taking 200 mg of ibuprofen three times a day, and determined that it does reduce the pain.

About a week before an MRI of my lower spine in January 2008 I quit taking ibuprofen. The pain in the left leg got worse every day. On the MRI table I had high pain in the left leg because I could not move it much. Then I started taking ibuprofen, 400 mg twice a day, and the pain considerably subsided.

Ibuprofen relieves most of the bowel and urination problems. It reduces the leg-pain problem, but not enough.

University of Virginia Spine Unit:

I stopped taking ibuprofen about a week before I went to the Spine Unit at the Neurosurgery Department at the University of Virginia Medical School on 5 February 2008. However, two nights before going the pain kept me from sleeping, so I took 400 mg for two nights in order to sleep.

The day before I went to the UVA Spine Unit the pain had progressed to the bottom of the left calf and into the left heel, making it difficult to walk. The 5-hour round trip to UVA was a bust, because the MRI data had not been sent there before I went; apparently I was supposed to take the MRI disk with me. I had called to find out if I was supposed to take it and no one answered or later responded to me call. The doctor at UVA said that he would call me after he got and studied the MRI.

Epidural Steroid Injection (ESI)

In March and April of 2008 the pain had gone down to the left heel; so I had two epidural steroid injections in my lower spine, which helped greatly. In January 2011 and March 2011 I had two more injections because the pain had occasionally reached the left knee then and I was having mild stinging in the buttocks and both thighs when I slept on them.

My Worries about the Future:

If I take ibuprofen or another pain reliever for many years, will there be deleterious side effects?
If the pain continues to worsen, will my older body be less able to recover from an operation on my spine in future years?
Will I have to continue having ESIs every two years or so and what will be the side effects?

Medicines I Take:

Lisinopril 10 mg in the morning for moderately high blood pressure.
Guaifenesin 600 mg (Mucinex time release) in the morning and in the evening for sinus blockage.

Vitamins I Take:

Multivitamin ( 90 mg VitC, 3500 IU VitA, 400 IU VitD, 30 IU VitE, 50 mcg VitK, 1.5 mg Thiamin, 1.7 mg Riboflavin, etc. including metals, calcium, phosphorus & iodine.
Vitamin-C 1000 mg in the morning and in the evening. More when feeling a cold coming on.
Saw Palmetto 450 mg in the morning to reduce prostrate swelling.