L5 Vertebral Fractures and Lumbar Spondylolisthesis: Treatment Insights

Fracture of the lumbar vertebral arch at the fifth lumbar vertebra with lumbar spondylolisthesis?

Hello Director Shi, I have been suffering from a fracture of the lumbar vertebrae and lumbar spondylolisthesis at the fifth lumbar vertebra for over ten years.
Three years ago, I underwent surgery where screws were placed and a fusion procedure was performed (the lamina was removed, and the fractured areas on both sides were supplemented).
However, there has been no improvement post-surgery; in fact, I have been feeling increasingly uncomfortable.
I experience soreness from my lower back down to my left leg, and sometimes my left leg feels numb.
Recently, even my knee has been aching.
In June of this year, I had an MRI, which showed no nerve compression, but there is damage to the intervertebral disc (the disc appears darker and flatter compared to others).
Could the pain be due to the intervertebral disc issue? Is there any way to improve this condition? Additionally, I constantly feel discomfort at the site of the screws (with pain on the left side).
Is it possible to remove the screws? Would there be any potential risks or long-term effects from the removal? I hope you can provide your valuable advice.
Thank you! Joan

Joan, 30~39 year old female. Ask Date: 2008/07/16

Dr. Shi Guozheng reply Orthopedics

After surgery for spondylolisthesis, if the bone fusion is complete, symptoms can be alleviated, and at that time, the screws can be removed.
The removal of the screws carries minimal risk.
Damage to the intervertebral disc can cause pain; therefore, it is advisable to undergo rehabilitation first.
If there is no improvement, consider consulting another physician for an evaluation to determine whether intervention for the disc issue is necessary.

Reply Date: 2008/07/16

More Info

Hello Joan,
Thank you for sharing your detailed medical history regarding your L5 vertebral fracture and lumbar spondylolisthesis. It sounds like you've been through quite a journey with your back issues, and I understand how frustrating it can be to experience persistent pain despite undergoing surgery.

From what you've described, it appears that your symptoms may indeed be related to the condition of your intervertebral discs, particularly the L5-S1 disc, which has been noted to be degenerated and less hydrated compared to other discs. Degenerative disc disease can lead to a variety of symptoms, including pain that radiates down the legs, as well as numbness or tingling sensations. The fact that you are experiencing discomfort from your lower back to your left leg, and even into your knee, suggests that the nerve roots may be affected, even if imaging studies do not show direct compression.

Regarding your question about whether the pain is due to the intervertebral disc issues, it is quite possible. Degeneration of the disc can lead to inflammation and irritation of the surrounding structures, including the facet joints and nerve roots. This can result in the symptoms you are experiencing. Additionally, the presence of hardware from your previous surgery may also contribute to discomfort, especially if there is any irritation of the surrounding tissues.

As for treatment options, there are several avenues you might consider:
1. Physical Therapy: Engaging in a structured physical therapy program can help strengthen the muscles supporting your spine, improve flexibility, and alleviate pain. A physical therapist can tailor exercises specifically for your condition.

2. Pain Management: Medications such as NSAIDs (non-steroidal anti-inflammatory drugs) can help manage pain and inflammation. In some cases, corticosteroid injections may be recommended to reduce inflammation around the affected nerve roots.

3. Alternative Therapies: Some patients find relief through alternative therapies such as acupuncture, chiropractic care, or massage therapy. These can be beneficial in managing pain and improving function.

4. Surgical Options: If conservative measures fail to provide relief, you may want to discuss the possibility of further surgical intervention with your orthopedic or neurosurgeon. This could include the removal of the hardware if it is determined to be a source of pain, or even a revision surgery to address any ongoing issues with the spine or discs.

Regarding the removal of the hardware (the screws and rods), this is a decision that should be made in consultation with your surgeon. While hardware removal is generally safe, it does carry some risks, including the potential for instability in the spine if the underlying issue has not been resolved. Your surgeon will assess the potential benefits and risks based on your specific situation.

In conclusion, it is essential to have an open dialogue with your healthcare providers about your ongoing symptoms and treatment options. They can provide you with a comprehensive evaluation and help you decide on the best course of action moving forward. Remember, you are not alone in this journey, and there are various strategies available to help manage your pain and improve your quality of life.

Best wishes for your recovery, and I hope you find the relief you seek soon.

Sincerely,
Doctor Q&A Teams

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