L5 Spondylolisthesis: Symptoms, Risks, and Treatment Options

Q: L5 Spondylolisthesis: Symptoms, Risks, and Treatment Options

Hello： 1. Is it possible for this condition to worsen, or can I coexist with it? A： It may worsen. If you feel you can walk and tolerate the symptoms, you can coexist with it (however, it will not be cured) - think of it like continuing to drive an old car. 2.

L5 and sacral vertebrae slippage

Hello Dr.
Lai, I would like to ask about my condition.
I have a fifth lumbar vertebra with spondylolysis and spondylolisthesis.
Some doctors have said it is grade IV spondylolisthesis, while others have described it as severe.
I first discovered this condition five years ago when I was pregnant.
Doctors at larger hospitals have recommended that I undergo fusion surgery, while orthopedic doctors at medium-sized hospitals have mentioned that it affects my daily life, causing pain and numbness that make it difficult to walk and sleep.
On a daily basis, I experience frequent muscle soreness in my lower back, which can be alleviated by soaking in a bath or getting a massage, but I do not have numbness or weakness unless I walk a lot, which leads to fatigue.
I had an MRI last week, and the evaluating doctor simply mentioned when I should schedule surgery.
I would like to ask the following questions:
1.
Is it possible for my condition to worsen, or can I coexist with it?
2.
If I do not have surgery, is there a risk of being unable to walk or experiencing nerve compression as I age?
3.
If I undergo surgery, is there a chance I could have a non-fusion procedure, or is fusion surgery the only option?
3.1.
I have seen information online about non-fusion spinal surgery, but I have never heard any doctors at large hospitals suggest it.
4.
Can this surgery be performed minimally invasively? How long does it typically take? Will it require an open procedure?
5.
Is there a possibility that after surgery, my occasional soreness could turn into persistent pain and numbness?
6.
Does my condition classify as grade IV spondylolisthesis?
7.
What is your recommendation?
Thank you, Dr.
Lai, for your response.
I am attaching the MRI report and imaging findings:
MRI of L-Spine with -Screen Save, 3 plane loc, Sag T2 frFSE, Sag T1 FSE, Sag T2 FSE STIR, Ax T2 FSE, Sag T2 loc up.
The vertebrae numbering method: counting from C1 or C2 inferiorly; 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae.
* Narrowing of L5-S1 intervertebral disc space.
* Mild bone marrow edema along the L5-S1 endplates, indicative of Modic type 1 inflammatory endplate changes.
* Anterior displacement of the L5 vertebral body suggesting grade II spondylolisthesis of L5 on S1.
* Spondylolysis of L5 with separation of L5 pars interarticularis.
* The spinal canal and the bilateral neuroforamina are within normal limits.
* Narrowing of the spinal canal at L5-S1 due to spondylolisthesis, diffuse posterior protruding disc, and hypertrophy of bilateral ligamentum flavum.
Impression:
1.
Grade II spondylolisthesis of L5 on S1
2.
Narrowing of L5-S1 intervertebral disc space
3.
Spondylolysis of L5 with separation of L5 pars interarticularis
4.
Narrowing of the spinal canal at L5-S1 due to spondylolisthesis, diffuse posterior protruding disc, and hypertrophy of bilateral ligamentum flavum.
KUB [supine], Lumbar spine [Lat: Flexion and Extension] showed:
- Scoliosis of the spine
- Narrowing of the sacroiliac joint
- Calcified density noted in the right pelvis; possibly a phlebolith or lower ureteral stone
- Some fecal material could be seen
- Grade II spondylolisthesis of L5 on S1
- Spondylolysis of L5 with separation of L5 pars interarticularis.

Amber, 40~49 year old female. Ask Date: 2023/08/31

Dr. Lai Zhaokang reply Neurosurgery

Hello:
1.
Is it possible for this condition to worsen, or can I coexist with it?
A: It may worsen.
If you feel you can walk and tolerate the symptoms, you can coexist with it (however, it will not be cured) - think of it like continuing to drive an old car.
2.
If I do not have surgery, is there a possibility that I will be unable to walk or experience nerve compression in old age?
A: It is possible.
It depends on whether you will live to see that day.
3.
If I have surgery, is there a chance to use a non-fusion technique, or is fusion surgery the only option?
A: Your MRI report indicates Grade II spondylolisthesis.
A fusion surgery is recommended.
(Non-fusion = motion-preserving.
Your spondylolisthesis is unstable, so non-fusion is not recommended.)
3.1 I have seen information online about "non-fusion spine surgery," but I have never heard a doctor at a major hospital suggest it.

A: As mentioned, it is not suitable for your spondylolisthesis.
4.
Can this surgery be performed minimally invasively? How long does it take? Or does it require an open back surgery?
A: It can be performed with minimally invasive decompression + fusion + bone screw fixation.
My surgery took about 2 hours.
If other doctors are involved, you should ask them.
5.
Is it possible that after surgery, my occasional soreness could turn into persistent pain and numbness?
A: It is possible, but the likelihood is low.
6.
Does this count as Grade IV spondylolisthesis?
A: As stated above, your MRI report indicates Grade II (Grade II spondylolisthesis).
7.
What is your recommendation?
A: 1.
If you are troubled and want a cure, consider surgery.
Try to choose minimally invasive surgery (though there may be out-of-pocket expenses) and select a skilled and compatible spine specialist.

2.
If you want to coexist, continue driving your old car until you can no longer tolerate it.
Just keep in mind that delaying surgery may reduce its effectiveness.

3.
Ask yourself what your inner voice is telling you.
Wishing you well.

By Dr.
Lai Chao-Kang, Chief of Spine Surgery, Changhua Hospital.

Reply Date: 2023/08/31

More Info

Understanding L5 spondylolisthesis, particularly in the context of your symptoms and MRI findings, is crucial for determining the best course of action. Spondylolisthesis occurs when one vertebra slips forward over another, which can lead to various symptoms and complications. In your case, you have been diagnosed with Grade II spondylolisthesis of L5 on S1, which indicates a moderate degree of slippage.

Symptoms and Risks
1. Potential for Worsening Symptoms: Your current symptoms, including muscle pain and occasional weakness, can indeed worsen over time. Spondylolisthesis can lead to increased pressure on the spinal nerves, potentially resulting in more severe pain, numbness, or weakness in the legs. If left untreated, the condition may progress, leading to more significant nerve compression and possibly affecting your mobility.

2. Long-term Consequences of Non-Surgical Management: If you choose not to undergo surgery, there is a risk that the condition could lead to chronic pain or even disability in the future. Nerve compression can lead to permanent nerve damage if not addressed, which could result in loss of function or mobility as you age.

Treatment Options
3. Surgical Considerations: The primary surgical option for spondylolisthesis is spinal fusion, which stabilizes the affected vertebrae. Non-fusion techniques are available but are typically reserved for specific cases where the vertebrae are stable. Given your Grade II spondylolisthesis, fusion surgery is often recommended to prevent further slippage and alleviate symptoms.

3.1 Non-Fusion Surgery: While non-fusion techniques exist, they may not be suitable for your situation due to the instability associated with Grade II spondylolisthesis. These techniques are more commonly used in cases where the spine is stable and the goal is to preserve motion.

4. Minimally Invasive Surgery: Many spinal surgeries can now be performed using minimally invasive techniques, which involve smaller incisions and less disruption to surrounding tissues. This approach can lead to quicker recovery times and less postoperative pain. The duration of the surgery can vary but typically lasts around 1-3 hours, depending on the complexity of the case.

5. Post-Surgical Outcomes: It is possible that after surgery, you may experience changes in your symptoms. While many patients report significant relief from pain, some may experience new sensations, including numbness or tingling, as the nerves heal. However, these symptoms often improve over time.

6. Classification of Spondylolisthesis: Based on your MRI report, you have Grade II spondylolisthesis, not Grade IV. Grade IV indicates a more severe slippage, which is not the case for you.

Recommendations
7. Consultation and Decision Making: Given your symptoms and the potential for worsening, I recommend discussing your options thoroughly with your orthopedic or neurosurgeon. They can provide insights based on your specific case and help you weigh the risks and benefits of surgery versus conservative management. If you are considering surgery, ensure you understand the procedure, recovery expectations, and any potential complications.

In summary, while it is possible to manage spondylolisthesis conservatively, the risk of worsening symptoms and long-term complications may warrant surgical intervention, especially given your current quality of life concerns. Engaging in a detailed discussion with your healthcare provider will help you make an informed decision tailored to your needs.

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