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Surgical treatment for Spondylolisthesis - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: Brain and Spine
Answered by

General & Family Physician
Practicing since : 2009
Answered : 681 Questions
User :   good morning
User :   am typing from east africa
Doctor :   How can i help you?
Doctor :   Ok
Doctor :   Please proceed with your query.
User :   we dont have any reliable docs here - and i need to know if i need to 'panic'
User :   i have spondylolitshesis l4/5 and loss of normal curvature of cervical a probability but trying to avoid
Doctor :   Please explain in detail.
User :   have had bilat CTS surgery in feb this year
Doctor :   Since when are you having spondylolitshesis? What symptoms are you having right now? Also may i know your age?
User :   left arm is 'weak' and often paniful
User :   I am 46 now......spondy diagnosed 2 years ago after severe pain and foot drop
User :   lower back pain, 'nerve' pain down left leg through buttock and then side of leg....
User :   but is my left arm and neck bothering me more at present
Doctor :   Are you on any medications?
User :   arm always feels week......
User :   crestor 10mg, eltroxin 1mg and cymbalta 60mg
Doctor :   Has the pain increased in recent times? Is there any tingling, numbness in arm?
User :   numbness is almost constant....not increased....what is happening more frequently tho is a sensation of the chills in back of left arm, top of shoulder and up neck.....experienced for several months now....
Doctor :   If you are not getting relief from the conservative treatment then surgery is a better option. It is done based on the type of spondylolitshesis
User :   but would this cause the sensation in my arm and neck?
Doctor :   Since the nerves are being compressed and causing the symptoms surgery would be decompression.
User :   so you are saying that nerve compression can cause the sensation of chills in my arm and neck?
Doctor :   Yes
Doctor :   Did you go for any Physiotherapy?
Doctor :   Are you on any injectables?
User :   have been doing bio kinetic exercises....
User :   no...did have epidural over a year ago
User :   have an almost constant 'headache' as well...
Doctor :   Patients with tingling and numbness benefit from epidural. Did you not have relief?
Doctor :   Yes headache is a common side effect of that.
User :   have been trying the conservative approach to this as i would have to travel to south africa for surgery and then spend several months there andhere in Tanzania...... cannot afford the time off work
User :   for a few months after epi, yes, relief.....
User :   essentially, i wanted to know whetehr these strange cill sensations could be caused by my back and neck injuries
Doctor :   Did you go for any brace?
User :   i do have a brace...wear when driving as the roads are terribly bad here
Doctor :   The symptoms which you are manifesting are mainly due to spondylolisthesis only and since conservative treatment is not helping surgery is the option left.
User :   hold please..just paying for an add 15 mins
Doctor :   Conservative treatments you have already followed as pain killers, injectables, exercises and brace
Doctor :   Ok
User : I still chatting with you?
Doctor :   Yes, please proceed
User :   thanks
User :   why would spondy cause these sensations in my neck and arm?...or is rather from the loss of normal curvature cervical noted in MRI Jan 2009??
Doctor :   These symptoms could be due to narrowing of the space of nerve roots.
Doctor :   Also loss of normal curvature would be a contributing factor.
User :   hwat are the outcomes of 'ignoring it for a few months longer'
Doctor :   Do you mean ignoring the surgery for few months?
User :   yes
Doctor :   Avoiding the surgery can make the condition worse and symptoms may be increasd.
User :   ortho in sa whom i saw last jan (2009) told me to look out for symptoms that could suggest worsening....loss of bowel / bladder function......this is still fine......tho i do worry am going to hit a bump in one of the roads here and snap my spine in half
Doctor :   Since Jan 09 have you noticed much change in your symptoms? Are they deteriorating?
User :   I digressed. Can the fact that the thumb on my left hand battles to straighten after periods on non use also be attributed to this cervical thing?
User :   yes, there is a generally deteriotaion if I am honest...altough have noyt had the foor drop episode that sent me for the xrays in the first instance....
Doctor :   Yes thumb can be affected by that.
User :   sometimes it feels as if I have to concentrate really hard if I to use my back......hard to explain......if I am benidng over and then have to straighten up i have to think hard about what it is i need to be doing to get my back to work......does that make sense?
Doctor :   Its good that you did not have foot drop episode. Is there any tightness or spasm in hamstring muscles?
User :   YES!
User :   often feels as if i have been running a marathon.....
Doctor :   Spondylolisthesis does cause back pain and stiffness with intermittent pain in legs, also hamstring tightening is also a later feature.
User :   honest answer here, doc....
Doctor :   Bowel and bladder function are affected lately along with cauda equina syndrome
User :   what will i be doing to myself if i ignore it for as long as i can......i so dont want to have to spend months away from home and my work....
User :   what is cauda equina syndrome??
User :   cos we dont have the docs or facilities HERE to get this done
Doctor :   Cauda equina syndrome is a neurological condition in which the entire nerve plexus is affected up to the level of spinal cord termination
User :   and symptoms?
User :   would be such as i am starting to experince.....??
Doctor :   It can be low back pain, pain in buttocks, sciatic nerve pain, bladder and bowel affected, decreased reflexes
User :   ok....all of those except the bladder/bowel ones...for which I guess I ought to be grateful!!
User :   what exactly would be bladder/bowel symptoms be, doc?
User :   loss of control?
Doctor :   Bladder disturbance can be urinary retention, hesistancy, urgency, incontinence
User :   i over balance if i try to stand on left leg.......
Doctor :   Bowel can be constipation, loss of anal tone
User :   ok...then the rentention might be starting to be an issue....noticed this of late.......
Doctor :   Ok
User :   could the bowel thing also be a fecal urgency issue?
User :   or a sensation of not emptying properly??
Doctor :   Yes it can cause incontinence
Doctor :   And retention
Doctor :   Also loss of anal sensations.
User :   I am SO afraid of the surgery........
Doctor :   I will advice you to go for surgery first as health is more important then work.
User :   am allergic to every single anti inflam on the market.......and tramadol
Doctor :   You need not be, at least you would be relieved.
User :   wear a bracelt as this was discoverd when i had epidural done....
User :   am listening to you..........these days?? outcomes of this kind of surgery??
Doctor :   But brace would not cure the disease.
User :   ortho in South africa did say probability of wide disk decpomp and then fusion l3 to sacro ilaic crest
Doctor :   Surgery would definitely help you in alleviating the symptoms
User :   no, the bracelet is to inform people of my allergy to anti inflasm and tramadol (in case I am unconscious)
User :   how liekly is this lkind of surgery to cause furtehr degeneration up the rest of spine?
Doctor :   Yes decompression of the nerve will be performed
Doctor :   You can be given other antiinflammatory medications which would not be allergic.
Doctor :   Usually patients respond well to the surgery
User :   really??? such as?
Doctor :   Oh ok
User :   with the exception of sleeping tabs...but they will give you valium as an alternative
User :   i have tried pyroxicamn - major allergic reaction to that
User :   also the usual ones......voltaren, etc...allergic to all
Doctor :   You shouldnot go for OTC then
User :   I dont......i just live with it
User :   and use a muscle relaxant when really bad.....codeine and doxcylclamine succ
Doctor :   That is better.
User :   see time is almost up again and i want to thank you before i am cut off.....appreaciate your time immensely!!
Doctor :   You are always welcome
Doctor :   Take care of yours
Doctor :   Thanks for consultation
Doctor :   Wishing you Good Health

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