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Dr. Andrew Rynne

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Have grade 1 anterolithesis L5 on S1 and nerve root impingement. Safe for scuba diving course?

Answered by
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Dr. Saurabh Gupta

Orthopaedic Surgeon, Joint Replacement

Practicing since :2004

Answered : 5930 Questions

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Posted on Mon, 7 Jan 2013 in Bones, Muscles and Joints
Question: My son has grade 1 anterolithesis L5 on S1 secondary to a bilateral pars defect diagnosed in 2008 when he had acute back pain with a viral infection. He has minor disc annulus bulges at L4/L5 and L5/S1 without evidence of canal stenosis or nerve root impingement. He does not have any pain and plays hockey regularly. Should he do a scuba diving course?
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Answered by Dr. Saurabh Gupta 2 hours later
Hello,

Thanks for posting your query.

Your son is suffering from isthemic spondylolisthesis grade 1. It is a condition in which one of the vertebra (usually L5) becomes misaligned anteriorly (or slips forward) in relation to the vertebra (or sacrum) below. This forward slippage, which can also be called an anterolisthesis, is typically caused by a "problem" with the pars interarticularis - the weakest part of the posterior arch of a vertebra that normally prevents forward slippage.

Isthemic variety is most common form and defect is usually acquired between the ages of 6 and 16 years and that the slip often occurs shortly thereafter. Once the slip has occurred, it rarely continues to progress.

In your son case, the slip is mild, there is no any canal stenosis or nerve root impingement and he is asymptomatic. So do not worry, he can continue to play hockey regularly and he can do scuba diving course.

Hope this answers your query. Let me know if you have any more concerns.

Wishing you good health

Regards
Dr Saurabh Gupta

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MRI OF LUMBOSACRAL SPINE: -

PROTOCOL:

-     SE T1W & TSE T2W SEQUENCES IN SAGITTAL PLANE.
-     TSE T2 W SEQUENCE IN AXIAL PLANE.
-     STIR SEQUENCE IN CORONAL PLANE.
-     MR MYELOGRAPHY USING HEAVILY T2W SEQUENCE IN SAGITTAL AND CORONAL PLANES ON A 1.5 TESLA SCANNER.

There is some degree of straightening of lumbar lordotic curvature. Vertebrae are normal in height, alignment and marrow signal intensity.
Dessicative disc changes and anterior osteophytes are noted at multiple levels. Disc height is reduced at L4-5 with degenerative endplate changes at this level.

There is diffuse disc bulge, thickened ligamentum flavum & facet joint arthropathy at L4-5 compressing the thecal sac and causing spinal canal stenosis with bilateral neural canal compromise (L>R). The mid sagittal diameter and area of spinal canal are 0.8cm and 0.75cm² (lower normal limits are 1.0cm and 1.5cm² respectively. Effusion is detected in the facet joints.
Annular tear, diffuse disc bulge and facet joint arthropathy are visualized at L3-4 indenting the thecal sac.
Diffuse disc bulge is observed at L5-S1 mildly compromising the neural canals bilaterally.

Cord ends at L1 vertebral level and shows normal signal intensity. No abnormal pre or paraspinal soft tissue mass is seen. MR myelography confirms the above findings.

Impression      :     MR findings reveal lumbar spondylotic changes with
     -     Diffuse disc bulge, thickened ligamentum flavum and facet joint arthropathy at L4-5 compressing the thecal sac and causing spinal canal stenosis with bilateral neural canal compromise (L>R).
     -     Annular tear, diffuse disc bulge and facet joint arthropathy at L3-4 indenting the thecal sac.
     -     Diffuse disc bulge at L5-S1 mildly compromising the neural canals bilaterally.

-     To be correlated clinically.

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