Print This PageBack Surgery Best for Patients with Degenerative Spondylolisthesis
June 6, 2007
by: Sylvia Marten
The recently released results of the second SPORT study showed that patients who selected surgery to treat their lumbar degenerative spondylolisthesis had better outcomes when compared with those who selected nonsurgical treatment. The study included two groups of patients:
Randomized group – 304 patients
In the randomized group, 304 patients were randomly selected to receive either standard posterior decompressive laminectomy (with or without a spinal fusion) or nonsurgical care. Nonsurgical treatments included physical therapy, epidural steroid injections, NSAIDS, and opioids. There was significant crossover from patients in the surgical and nonsurgical groups, with 64% of the surgical group having surgery and 49% of patients assigned to nonsurgical care also having surgery.
Because of the large percentage of patients who crossed over to from non-surgical treatment to surgical and vice-versa, the results of the study are really only meaningful by evaluating how the patients were actually treated, (vs. by their randomized groups).
Observational group – 303 patients
This group was allowed to choose whether to have surgery or receive nonsurgical treatment. 97% of patients who selected surgery went through with the operation, and 25% of the nonsurgical group ultimately chose surgical treatment.
The surgery for spondylolisthesis included a decompressive laminectomy with or without an accompanying spinal fusion.
The large cross-over of patients and the favorable outcomes show what doctors and patients already know: those with pain fare best when their care was left to the individual discretion of patient and surgeon.
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Subject: Thank you for your
June 6th, 2007
Subject: Debating Surgery for Spondy Grade 3
I'm a 40 yr. old mother of 2 (ages 3 and 5 yrs.)who was diagnosed with spondy grade 2-3 prior to becoming pregnant. I did PT, cortisone shots, and some mind/body stuff. After giving birth it seemed to progress to a strong 3, almost 4 grade. After meeting with 3 surgeons 2 years ago I decided to go down the PT route once more and make sure I had exhausted my options prior to surgery. I am now in excellent shape re: core strength. I have been playing quite a bit of tennis and have been in major pain for the past 2 years. So, although PT has helped in some ways I am still left with chronic pain in the night and every morning waking up. I want to be very active and will not give up sports.
I have concluded it's time for spinal fusion as I cannot take the chronic pain anymore and am pretty sure after the fusion and a careful recovery, my pain will be gone and I will be able to play sports like tennis.
Any feedback would be greatly appreciated as I am moments away from scheduling the fusion. I am obviously a little scared about such a big surgery and am trying to get all info or thoughts possible before doing so.
August 1st, 2008
Subject: Debating Surgery- Spondy grade 3 and DDD ???
I am about to see a spinal surgery nuerosurgeon for the first time, since referral 1 yr ago from an ortho who doesn't do lumbar fusions. I have an L5-S1 slippage at about 50%- not sure if it will be graded 2 or 3, as the xrays used May 07 were already several years old. They showed that degree of slippage and essentially no disc present. I am not able to sleep well, sit, stand, drive, pretty much only constant motion alleviates pain for me. The pain radiates from that part of my back and across mostly left hip. My left foot and calf seem kind of numb. I am so sick of being in pain all the time and my portable tens unit doesn't seem to help much any more. It feels like someone is stabbing me with a knife. If I sit for a couple of minutes, I have a very hard time standing upright. It takes a while for me not to walk hunched over and limping and hurts like crazy until it lets go. I am 43 years old and have tried everything- including cortisone injections. Pain meds do very little good at all. I've been afraid to have surgery and wondered about trying to get to a more optimal weight and core strength, but the pain is so bad and exhausing, it hurts a lot to exercise. I am afraid this might ruin my life- I have no sick time and have no idea how we'll pay our bills if I have to be off for three months- or even if they'll keep my job. Guess I'm venting a bit, but would love to hear from anyone who has dealt with this. Are there any reseacrh studies I could check on to learn more about this specific type of surgery & success rates?
Thanks for any help.
August 5th, 2008
Subject: I think you should go ahead
I think you should go ahead and build strength and get to an optimal wieght. My PT has been a life saver, mentally it puts me in a good place and my core is very strong. So, alghough it has not alleviated my pain it has prepared me for surgery and has been great for my overall health. A good PT will not encourage excersises that hurt and it's at least something you can do for your condition.
Surgery is a good option after exhausting the above. AS far as job, bills and rehabilitation that is a personal situation that you will have to speak to your employer about.
I have similar pain and feel as though surgery will help. You must pick a good surgeon with experience in fusions.
Good luck.
August 6th, 2008
Subject: Thanks for responding. I had
Thanks for responding. I had a new MRI that shows bulging disc as well as the spondy. I can't wait to see the neurosurgeon now. Getting in my best shape before surgery (if recommended) is logical- tho hard. Take care & hope things work out for you. I am soooo tired. Write if you decide to schedule suregry.
August 13th, 2008
Subject: You are just like me!
I thought I was crazy--- I know exactly what you are talking about: the hip and thigh pain, constant pain, difficulty sleeping. It is so hard!
What have you decided to do-- I am holding off on surgery, but I do not know how much longer I can-- again, like you I have been trying unsuccessfully to get to a better weight- a catch 22-- it's hard to do when it is hard to move.
I'd love to hear more from you-- I was just amazed how similar everything was. It's hard for people to understand unless they are going through it.
August 20th, 2008
Subject: how to find doctor
I can't wait until next week. I have an appt with one neurosurgeon on Tuesday and another one (different practice) on Wednesady. I know the one has done 560 surgeries in the past two years- 85% of them on the spine. What I don't know is - is this good? How many makes for an "experienced" doctor? How have any of you figured this out?
Another thing- I wonder about AxiaLif, which is a much less invasive surgery for L5-S1, but when I look for Doctors who use this, even Dr. Ullrich, who helped start this website is not listed as an AxiaLif Dr. Thoughts, anyone?
If I have a desk job and a 20 minute highway drive to work, how long do you think I will have to be off work if a fusion is recommended?
Thanks to all.
August 27th, 2008
Subject: fusion or not a fusion!!
Hi Martyon, just read your post, it all sounds so familiar,
i don't reccommend spinal fusion purely from my own experience, not a fusion with metal work anyway, i had mine done 14yrs ago like you i had a slippage of over 50% i was in hospital for `14days in a back brack for a yr and then a corset for another 2yrs, i now have nerve damage same place as fusion L5/S1 pain in opposite side of nerve damage because of metal work they can't see whats going on consultant suggests revision lumber surgery ie. removal of metal work he has told me to look it up and then decide. may add i'm not over weight, as being to heavy does'nt help either.
Good luck with what ever you decide.
June 9th, 2009
Subject: Spondy L5 - S1
I am new this is my first posting. I have had back pain for many years and was diagnosed last week with Degenerative Spondylolisthesis. My Dr. wants to do an Anterior L5 S1 Fusion. I have a displacement of L5 of about 50% and he said my spine is very unstable. The pain has gotten worse over the last month or so with numbness now in both legs. I was diagnosed with restless legs but now the Dr. says it is the nerve being pinched not restless legs. I am afraid of the surgery but I know that I don't have much choice.
I am trying to decide if I can or should get the Epidural injection or just have the surgery. The injection might help with the pain but will not do anything about the nerve pain in my legs.
Anyone out there know about Anterior L5 S1 spinal fusion? Any comments would be appreciated.
Ellen
June 13th, 2009
Subject: epi inj
Hi, hopefully the epi inj should help the nerve pain, the nerve inpingement that causes sciatic pain in the bum,thigh,legs and even the souls of feet is caused by inflammation from damaged disc ect pressing on the nerves, I had my epi in march after 8 months of sciatic pain ,thank god 2 hours after the epi inj the sciatic pain was gone and has not come back, I have 50% plus slippage of L5 & S1 vertabra, wish you all the best with whatever you decide but personally would opt for epi inj before surgery and get your gp to refer you to a pain consultant, gabapentin,cocodomol and diclofenic gel have helped me to delay surg, epi inj is a good low risk option before surgery,if your spine is unstable the epi inj could reduce bilateral nerve pain and then you could have surgery later,if you opt for surgery straight away to stabalise spine it will not reduce nerve pain only fix the vertabra and stop them from moving,it will not reduce inflammation like the steriod inj does, all the best, kind regards
June 27th, 2009