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Does My Apprentice Fitter Job Lead To Spondylolisthesis Or Spinal Stenosis Inspite Of Having Bilateral Spondylolysis?

Posted on Fri, 14 Mar 2014

Question: Hello my name is XXXXXXX I'm a 22 year old apprentice fitter and XXXXXXX I have been diagnosed with bilateral spondylolysis and postercenteral disc herniation also at L5\S1. The date of injury was 11\10\13 i have been off work completely until present, I have had severe pain around buttocks and legs, I have trouble sitting, standing or traveling for even short distances. For treatment I have had physiotherapy and nurophen plus pain killers. I have recently seen a specialist on the 21/01/13 and he has said I should be okay for light duties and be back on to full duties within 4 to 6 weeks. This sounds crazy for the amount of pain my back is still in, I would appreciate your opinion, What do you think my prognosis for life with spondylolysis working in a manual intensive job as a fitter and turner? will doing this job eventually lead to spondylolisthesis or spinal stenosis? What is a average timeline to recover from spondylolysis? Awaiting your reply Regards XXXXXXX

Answered by Dr. Sudhir Kumar (12 hours later)

Brief Answer: My reply is below. Detailed Answer: Hi Mr XXXXXXX , Thank you for posting your query. I have also seen your MRI of lumbosacral spine and the report. I agree that your MRI reports do not show any significant compression of the nerves in the back, and hence, you should recover fast. Medications helpful for you would be pregabalin or gabapentin or duloxetine capsules. In addition, you require good and intensive rehabilitation process, including IFT/traction/ultrasound, etc. Back extension exercises would also help you. 4-6 weeks of time seems reasonable for good recovery in your case. You should avoid lifting heavy weight and forward bending now, and also later, when you join work. I hope my reply has helped you. I would be pleased to answer, if you have any follow up queries or if you require any further information. Best wishes, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (9 hours later)

Hi I had no improvements until 10 weeks into recovery at this present time my leg pain has resolved they only start to radiate if I'm sleeping on my side or stand or sit to long, but i still have a lot of pain around my lower back and very limited range of flexion and extension I am now 13 weeks into recovery why do you think it is taking so long?

Answered by Dr. Sudhir Kumar (3 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: Recovery may take longer in some people. As I mentioned earlier, it can be hastened with good neuropathic pain medications and intensive physiotherapy and rehabilitation process. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (32 hours later)

Hi thankyou for your time and reply's so far, my final question is can you have bilateral spondylolysis and not have a fracture? as I have showed my local GP the mri and report and he doesn't believe that there is a fracture? Thankyou XXXXXXX

Answered by Dr. Sudhir Kumar (5 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: Yes, you can have bilateral spondylolysis without a fracture. I also agree with your GP that your reports do not show a fracture. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (6 hours later)

Hi thanks again can you please explain my type of spondylolysis? And how it differs from a facture? Should the healing time be faster? Is my chance of developing spindylolythesis reduced by not being being fractured?

Answered by Dr. Sudhir Kumar (5 hours later)

Brief Answer: My reply is below. Detailed Answer: Spondylolysis is a mild degenerative process of spine bones, whereas fracture is separation of spine bone into two or more parts, usually due to trauma. You have the first one, and the healing time would be faster with spondylolysis, as compared to fracture. Yes, there is a lesser chance of spondylolisthesis. This risk is more in people who are overweight or those with weak bones (osteoporosis). Best wishes, Dr Sudhir XXXXXXX MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (8 hours later)

Hello I'm not trying to be rude but please see my attached CT scan results labelled L-SPINE0001 0002 0003 and the axial view L-SPINE bilat. I believe these indicate the fracture.

Answered by Dr. Sudhir Kumar (5 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: Yes, I agree with you that those pictures show a fracture of spinous process. However, no surgery is needed for that. It would heal over time with conservative (medical) management. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (4 hours later)

Thankyou! can you please explain to me as to which part of my report gave my GP and yourself the impression it was not fracured? as I now need to go back to my GP and convince him. Would my treatment be different now? whats the reccomended healing time for bilateral spondylolysis with a fracture?

Answered by Dr. Sudhir Kumar (4 hours later)

Brief Answer: My reply is below. Detailed Answer: Thank you for getting back. It is the MRI report (Daniel MRI report.jpg) which did not mention about the fracture. However, once you pointed out on the CT scan, it is quite clear! Treatment would still be with medications, physiotherapy and rest, as the feature seems to be old, and stable. So, no surgery is needed. It would take a total of 8-12 weeks for healing in this condition. Best wishes, Dr Sudhir XXXXXXX MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (27 minutes later)

Hello thank you for clearing that up, if i bring these images into my GP do you think he will understand? I have never had any back pain before the date of the injury? 11/10/13 these are my first scans, 14 weeks into recovery today 03/02/13 and still have low back pain and very minimal flexion and extension, would you recommend a back brace? should I have another CT XRAY MRI to check on healing before going back to my manual labour job very shortly?

Answered by Dr. Sudhir Kumar (19 minutes later)

Brief Answer: Thank you for getting back. Detailed Answer: Taking those CT scan pictures may help, but it would be better to get that reported by a radiologist and then, you can meet the GP with the official report. (I had those CT images reviewed by my wife, who is a radiologist and she confirmed to me that there is a fracture, I may have missed them on my own!) Back brace/lumbosacral corset would be helpful. Repeating a CT scan to look for healing of fracture would be a nice idea, before you join your manual labour job. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (2 days later)

Thankyou so much for your time and help, I have been to my GP with this conversation and CT images and he now agree on the fracture, I also have received my report from the specialist I saw in person on the 21/01/14 and it did not say a fracture either. So I have used this conversation as evidence and second opinion and he is now going to review my report. Again thankyou!

Answered by Dr. Sudhir Kumar (7 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: I hope you get the correct report and the best possible treatment based on that. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (13 days later)

Hello, I have had a recent MRI scan 17/02/14 of the healing of my bilateral spondylolysis and would like your opinion as my specialist still does not believe there is a fracture even after reviewing this conversation. I would very much love your opinion on the oedema around the pars, Your opinion on the healing? and my capabilities of light duties for a 8hr day? as i'm still in chronic pain have not had any improvement since we last spoke. Thankyou XXXXXXX See attachment of the latest "MRI 16 WEEK HEALING"

Answered by Dr. Sudhir Kumar (14 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: Thank you for getting back and informing about the progress so far. It is unfortunate that you have not improved and still suffer from significant pain. I agree that the MRI shows partial healing, and mild oedema is also noted. However, the fitness for job should depend on the actual symptoms of the patient and not merely on the basis of MRI findings. So, I feel that you should be allowed some more time before you are declared fit for an eight hour job. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (54 minutes later)

Hi, Thank you for your reply, Is the oedemo proof of healing of the bone fracture? What do you believe my condition is from the below opinions active or inactive? Active spondylolysis. On the SPECT scan an active spondylolysis shows uptake, and an MRI scan shows bone marrow edema adjacent to the pars defect. These findings indicate that there is activity/movement associated with the pars defect, which is likely to produce symptoms of low back pain. Inactive spondylolysis. If there are no indications of activity with the pars defect, then the spondylolysis is considered inactive and any low back pain the patient is experiencing is probably incidental (meaning that there is probably another cause of the patient's lower back pain, such as a muscle strain).

Answered by Dr. Sudhir Kumar (6 hours later)

Brief Answer: My reply is below. Detailed Answer: Yes, the oedema could be the proof of healing. I think it is the former. Healing stage and that could explain the back pain. In addition, there could also be muscle strain, leading to more back pain. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (6 minutes later)

Thankyou again for your reply! So at the moment in your opinion should I be doing these activities that my specialist and GP have approved with a active spondylolysis? Sweeping the floor · Water blasting equipment · Metal lathe machining · Counting stock · Cleaning offices · Painting offices · Washing cars · Answering telephone calls · Lifting 20 litre drums via a trolley · Driving forklifts · Driving vehicles · Welding · Making hydraulic hoses PLEASE SEE ATTACHED NEW MRI PICS

Answered by Dr. Sudhir Kumar (8 hours later)

Brief Answer: No Detailed Answer: Thank you for getting back. If I were your doctor, I would not expect or allow you to do such strenuous activities with active spondylolysis. If at all, light activity can be permitted, and gradually over a period of time, more heavy activities should be allowed. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (16 hours later)

Thankyou! Your opinion made me very worried about attending to these light duties the following week coming, so I have visited another GP 1.5hrs away today but these GP's do not understand my condition, and cannot help once a specialist has made a call a GP has no say. The only chance I have is seeing this new specialist I have arranged for Thursday coming 27-02-14 When I finally get my treatment of back brace complete rest ect. what is the procedure for recover should checkup xrays be carried out regularly untill healing is evedient enough to ensure the pars interticularis is stable and no more oedema/pain is present?

Answered by Dr. Sudhir Kumar (9 hours later)

Brief Answer: There is no need to worry. Detailed Answer: I am sorry if my reply made you worry, it was not intended to do that. What I meant is that I would have waited for your symptoms (pain) to significantly subside before recommending hard work for you. Regular X-rays and MRI scans would be helpful in monitoring the healing process, however, clinical recovery of symptoms is the most important. Please keep me informed about the progress. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar