Surgical Options for Degenerative Lumbar Spondylolisthesis - Part 3
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- Опубліковано 2 чер 2024
- This video outlines the surgical options for Degenerative Lumbar Spondylolisthesis along with surgical risks, benefits and outcome.
Timestamps:
0:00 Start
1:00 #1 To fuse or not to fuse
2:00 #2 Lumbar decompression ULBD
3:39 #3 Goals of surgery
4:21 #4 Usage of pedicle screws in surgery
5:11 #5 Posterolateral Lumbar Fusion
6:10 #6 Interbody Fusion description
7:05 #7 ALIF - Anterior Lumbar Interbody Fusion
9:27 #8 LLIF - Lateral Lumbar Interbody Fusion
12:05 #9 TLIF - Transforaminal Lumbar Interbody Fusion
13:45 #10 - Length of surgeries
14:15 #11 - Length of hospital stay
14:24 #12 - Post-Op Procedures
14:43 #13 - Adjacent Level Disease
15:38 #14 - Laminectomy and risks
16:24 #15 - Benefits of surgery
#thespineguy #spinesurgery #lumbardegenerativespondylolisthesis #alif #llif #tlif #plif #posteriorfusion #lumbarfusion
Dr. Brian W. Su, MD
Spine Surgeon
Chief Development and Strategy Officer | California Orthopedics and Spine
Medical Director of Spine Surgery | Marin General Hospital
Director | Marin Healthcare District Board
Chairman | Marin Specialty Surgery Center
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Contact two locations:
www.caorthospine.com/
415-927-5300
2 Bon Air Road, Suite 120
Larkspur, CA 94939
7100 Redwood Blvd, Suite 200
Novato, CA 94945
Curriculum Vitae:
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FTC: This video is not sponsored.
Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Information obtained from this video should not be taken in lieu of your own medical provider's advice and treatment plan. Please consult directly with a physician or other healthcare professional regarding any diagnosis or treatment plan options. Content provided on this UA-cam channel is for informational purposes only and should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose , treat, cure or prevent disease.
Had Anterior and Posterior spinal fusion surgery for Spondylolisthesis/Stenosis two years ago and I am very glad I had it done.
Thank you for sharing, i’m supposed to have the same surgery my wedding is in 3 months i was wondering how you felt around the 3 month mark as i’m scared not only about the procedure but being able to function on the wedding day
@@dmcgarry07 By three months I was feeling a lot better.
How was your recovery? I have never had surgery but I have alot of spinal issues.
@@nicolewarner2035 For me it went smoothly, but I was working out up until the night of the surgery and was back to walking the morning afterwards. My surgeon had me walk for ten minutes four times a day for the first few weeks. That helped me out a lot. I'm also in my forties.
I live in Sac and have enjoyed your videos. UC Davis is proposing a fusion on l3-l4 and l4-l5 with decompression due to bone spur and soondelithesis. I have xrays (standing bending) and an mri. I would like to get a second opinion. Would you be interested?
3 weeks away from L4-S1 decompression and fusion. I am retired RN and always swore I would never have back surgery. I am nervous - down right scared at times - but your videos are informative and reassuring. Thank you. Now if there was just a way to speed up the recovery time.
Sending prayers your way , for a successful surfer and speedy recovery, if you can keep us posted, I to will need a L5-S1 fusion in the future ALIF
How did it go?
Excellent video my dr wasn’t great in explaining as he thinks laymen can’t understand enough!..
Your video helps me see and understand with visuals all that my new dr. Is gonna use on me in February!🙏🏻♥️✨Appreciate your support and reassurance of the process and procedure!!♥️✨🙏🏻
Can you tell me how recovery was? Did the surgery go well? Any complications?
How was your recovery following surgery and how do you feel now ?
This Dr is outstanding...We need help....Wow!! Unbelievable someone care's enough to explain!!
One more thing. I also have a curviture to the left. My question is I'm 61 so in 6 months to a year from now as the shots no longer work seems to me surgery would be a good idea as I have no quality of life even right now if it would give me 5 to 10 years of quality. I could mow my yard on the riding mower, I could plant my flowers and go fishing. I want to thank you for what you do. You have no idea how many people you are helping as to date NOT ONE SINGLE DOCTOR EXCEPT YOU has even tried to help me understand what is happening to me. God Bless you and MUCH GRATITUDE for all you do!!!!💖💖💖
Terry, I'm 71 yo, with this condition and others involving my spine from the neck, mid back and Lower back and Hips!. Agreed, not one of the 6 Neuro / Spinal Sugeons ever mentioned any of this. I've been to see doctors at Columbia Pres , Mt. Sinai and others. I have been told by all of Them, that there is No Surgery option for me. The highly regarded surgeon at Columbia actually said...No one is operating on your lumbar spine.....Far Too Much Arthritis. I would have to rebuild your lumbar spine!!".
Had a laminectomy and L4-L5 spinal fusion 6 weeks ago. All my pre-surgery symptoms are gone and my back is much stronger. Though this is not an easy recovery, it was worth it for me. Walking and physical therapy after is very important which I did do. I feel better than I have in 5 yrs.
Great idea for making these videos to educate spine patients. Your explanations are very comprehensive yet easily understood by the general population. This is what makes you stand out amongst all surgeons. You care enough to take time doing this!
That as the best spine presentation on you tube. Thank you.
Amazing!! We need direction and this is so helpful Dr.....
Your information and descriptions are wonderful. I only wish you had been my surgeon. I am now out from my laminectomy surgery 7 years ago and I’m still in pain 24/7. I have been referred to several pain doctors who have tried several treatments to address the pain, ablations, SCS which has not helped at all and I am pursuing its removal. I actually had 2 surgeries because a few days from the initial procedure, I was in intense pain and it was discovered that bone shards were left and required another surgery to remove them. Being in pain is no way to live a quality of life. Thank you for your videos.
I agree, an excellent video for a patient on the different options for spine surgery. Thank-you
Fascinating, yet intimidating!
This is an awesome video and how it’s explained has made me feel I can approach surgery if needed ,
Thank you so much for all that you do! 👍👍👍👍👍🙏🙏🙏🙏🙏🙏🙏🙏
Just great detail, and the attention to what the patient ‘ feels’ is important, and you show you always keep those things in mind as it affects an outcome for the patient. Thank you. Chet
So glad I came acriss this. If my doctor explanned this he would've lost me in the beginning but now I can replay this to my complete understanding. Thank you so much.
I appreciate your indepth explanation of the pros and cons of a spondy surgery. I am about to get my third epidural this year in a couple of days but if I have to have surgery I feel much better after watching this video. Thanks
Excellent information,Thank you
wow.. most honest dude yet since my surgery 2 years ago... my back pain is gone, my leg pain went from right leg to the left one, half as bad... L5-S1 fusion , L4-L5 dynamic fixation... IT's BEEN FUN...... 😠😡🤬 thanks for the proper explanation....
Great video, thanks so much for this information!
Hello Linda
Good video - very clear info presentation.
As others have noted, it's the adjacent disc disease that's the most worrying. At 71, the thought of doing this again in 10 years is horrifying. Great info nonetheless. Thanks.
I love your videos and thorough explanations! Wishing you the best! What an awesome human being, ❤
Thanks for the info , this is exactly what I have even my legs go numb , great video
I really enjoy watching ur informative videos I'm learning alot about my problem how it can be treated that's what I have I've had it for quite awhile
Excellent video, thanks
Im going for the operation on the 30/05 and your video helped me understand it very clearly. Thank you
Excellent presentation. I now have a better understanding of the process of mitigating lumbar disk & nerve pain. Than
AWESOME, ALIF COMING SOON
My goodness, your video was a gift from heaven to help me understand these methods and advise a dear friend. We will make it through this for sure...
Thank you Dr. Su! I was admitted into the hospital on Wednesday because of severe calf pain (no clot found) so when I came into the ER after speaking with my Neurosurgeon to get an MRI and he would meet me here. He removed C 5, 6, and 7 in my neck and replaced them with cartridges, screws, and plates. I've had absolutely, ZERO PAIN since the surgery that was in 2014.
In Oct 2021, he performed fusion at L4-S1, and inserted screws to stabilize my lower spine. I was awake and walking without ANY WALKER OR CANE approximately 2 hours from the recovery room to my room.
Last night, 2/22, I found out I need to have surgery for lumbar spondylosis. My Neurosurgeon said that he would make an incision into my abdomen first and start to work on my spine from the front. Secondly, he said he would make 6, yes 6 incisions in my back. I'm more worried about him cutting through my tattoos (🤣😂🤣) more than anything. My last back surgeon was low in my back and I told him he couldn't cut my "tramp stamp" or we'd both be in trouble if he cut it! He ended up making the incision BELOW the tattoo and he did a great job, you really have to get "in there" to find the incision. And my "tramp stamp", is Jesus hanging on the cross🤦🏽♀️
I must admit that I'm nervous as I've heard this is a "tough surgery" to recover from and it's severely, severely, painful!
I was supposed to have surgery on 2/23 but spiked a 102.4 temp so surgery is cancelled til Monday ao they can treat me today - Sunday with IV antibiotics just to mke sure if I had one that the antibiotics knock it out before he plans to operate on Thursday! My Neurosurgeon is the BEST in DFW and I'd recommend ANYONE to him!
Thank you Dr. Su for the vido, he tried to draw me a diagram on the white board but I'm afraid I had NO IDEA what he was drawing! I'm going to go watch your other videos about this very subject. Thank you from a 48 y/o that ran long distances my entire life, and can now hardly make it up 3 flights of stairs! Things have to turn around, I just have that intuition! Good luck to anyone who may have to have this, remember, walk, walk, walk although painful (I always take a shot before going to walk in the hallways, but the more walking you do, the faster than pain/stiffness goes away!
I would have to see the imaging you can make a zoom appointment by calling California orthopedics and spine
@@DrBrianSuTheSpineGuy I will absolutely ask them where on the patient portal I can find the "findings" and also the actual MRI. The said there were major changes since Oct. 2021, because I've fallen about 3 times onto my hardwood living room twice, and on my hardwood floor in my bathroom once. I had a MAJOR PANIC ATTACK at my Gma's 90th Bday party because of he person that r*ped me from age 4 to 14 was in attendance! I sat there all night next to my Police Chief Brother where I always feel completely safe! My Brother and SIL walked me to my room, made sure I got dressed for bed and left. A couple of hour later, I got up to go to the restroom. I'm not sure how much time had passed by I woke up in my back, with my knee's bent, a massive headache and my right hip was hurting. I managed to get back in bed and slept til 11:00am at checkout.
I'm more than sure I've damaged something! My MRI did show major changes but also saw a "moderate amount" of arthritis there that I didn't have in Oct. 2021.
Thank you again so much, I will get that MRI/report to you ASAP!
Thank you Dr. Su reaching out in such a busy time for you. I love your approach and bedside manner. Depending on what you think, I'll stay until the infection clears (a 34 yr "Nurse") accessed my Power Port without being sterile or having a sterile field or dressing, I called her out on it and she proceeded! I had no mask on even though I was facing the opposite way but she never had on one or a mask! 😡
Sadly the pain doesn't always go away sometimes I'm draging my leg just trying to walk the dog 🐶 😢. Al the best to u I hope it works out OK
WOW!
Thank you so much Dr Su for explaining how this surgery works! I’m in so much pain. In need of l4 l5 and l5 s1 tlif and one more thing that I can’t remember! I’m so very scared. But my quality of life is non existent! I’m hoping to have the surgery soon. Grateful for you compassion and explanation! ☮️💗🤗
Hi Jeanie
Very helpful -thanks
Hello Mary
Wonderful ❤
Crystal clear explanation doctor su.thank you for sharing that to us.it just seem expensive but given the chance i would like to go through it.
Hello Rosanna
Recently diagnosed with retrolisthesis/spondylolisthesis and severe stenosis. I want to thank you for your detailed explanation of the various surgeries. I will be much better equipped to discuss options with my doctor.
did you do surgery for it sir..... one of my relative is having same problem ... if yes then plz give your suggestions. thanks
@@muhammaddanyal6549 I had 3 level fusion of S1 to L5, L5 to L4 and L4 to L3. It was a difficult recovery the first few weeks, in particular. However, 9 months later I am pain free and doing remarkably well.
Thank you for this video, Dr. Su. I'm having an L4-S1 fusion on 7/24/23 and feel much more comfortable about it.
@@travisn23 Thank you. My surgery was a success and I am actually recovering ahead of schedule. NOTE: Days 4 & 5 post-surgery was HELL! If you have this surgery, do not be afraid to ask for heavy duty painkillers during the first week. I had in home PT for a month, and now I go in person for the next 2 months.
Thank you so much for your videos and excellent explanations of the procedures !!! I have been diagnosed with Grade 1 anterolisthesis of L2 on L3, with Spondylolisthesis of L2, Scoliosis. Also Degenerative changes with disc bulges. No significant central canal stenosis. Experiencing pain in lower back, legs and buttocks along with tingling and numbness in legs and feet. Have done physiotherapy along with chiropractic exercises which has given some relief but still experiencing the symptoms. Have appointment with Neurosurgeon but just wanted to say thanks again Dr Su for your excellent explanations. I was fearing surgery but I can’t go on not being able to do everyday activities along with sports and physical fitness especially at my age being 60 I feel it’s very important to stay active !!!
Wow, Perfekt Plannung
Thank you as I facing this surgery with the rod thing you showed. L4-5
I had PRP injected into the disc at L5-S1 at University of Utah!
I shared this with a friend who’s dealing with a lot of pain. She said girl let’s go see this surgeon
Thank you for explaining the options. I have spondylothesis l4/5. My lower leg is numb and my quad on right leg is weak. Been going to PT 3x week for 3 months. I've fallen because the leg just gives out at minimal flexion. I've had steroid injections and am basically getting by poorly on nsaids, gabapentin and muscle relaxers. I k8nda gave up on my orthopedic doc, it's always wait another month .
im an 18 year old who’s had issues with a grade 1/2 spondylothesis at the l5/s1 level since i was 15. ive had steroid injections, rounds and rounds of pt, a microdisectomy, and now finally an alif, yet i have never received such a comprehensive description of what would be done to me. thank you so much for demystifying the surgery and helping me be a little less nervous about the whole ordeal!!
You should watch the isthmic spondylolisthesis videos
thank you!!!!!!!!! you answered every question i have but my doc too lazy to explain!!!!! i need to know about waiting for TOPS procedure that was JUST FDA approved!
have appointment july 20 with one doc in Charlotte NC but we are now waiting for the hospital to approve! This could take year or more! I can't wait. I've been dying in pain for 1 1/2 years now, but was just recently diagnosed with Spondylolisthesis. Pain in leg began right after my successful hip surgery, same side!!!!! What's the chance of this????? I subscribed so I can find you easily! God bless you!
brilliant thank you
Fantastic overview. Thorough, well explained, helps you understand all the options. Thanks Dr.!
Very helpful! Sorry so long...Recent MRI shows I have spondylolisthesis and bulges at two levels and herniated disc at L5-S1, plus some stenosis. I'm 61, and had a C5-7 ACDF at 53. Side note -I also have fibromyalgia and trigeminal neuralgia and have been on a Cymbalta, Carbemazapine and Lyrica cocktail for two years. So when I first started having trouble walking with thigh and knee pain I blamed it on that. Now, a year later I've done lots of physical therapy for sciatica, hip pain, knee pain, and I had first ESI today. I'm very bothered by not being able to walk very far, sometimes the pain goes from lower inner thighs to knees, ankles, bottom of feet. I'm already unstable on my feet from meds- sure not comfortable with more. I'm seeing spine nurse practitioner who said "hopefully we can avoid surgery". Realistically, that doesn't seem likely to me. Thoughts?
Hard to know without seeing imaging. You may want to look at lumbar disc herniation video
I'm kinda the same I have this an slight spondylitis,fibromyalgia mines normally pain right side. They wanted to op on me over ten years ago. Yet other doc said cause I've had a spinal leak plus more than once I can die in my own fluid so haven't done anything. Sadly I can't take antiimflammatory they don't agree with me. Except steroids. Sadly I've had to change doctors twice so far as they keep messing with my meds. I can only have codeine paracetamol I was on morphine patches but stopped taking them cos they never stick in the heat. My doc now. Is trying to tell me&control what I have so I'm limited big time. They think they know better what I should have but never listened not really. When I have steroids it makes me walk better etc aswel I have proper morphine have never touched it. Don't get me wrong there is times when I feel like I should but still haven't cos if they mess around with this now what's even the point cos I won't get anywhere with them. I have a defect in the spine as my mum has hidden spineabitia spelt wrong I know. They reckon I haven't got nerve damage which I have my hand has a lump in it won't even scan it been asking for over a year now. Also have a sprink growing slowly so far in the spine itself. Have the bladder&bowel problem sometimes. I understand completely. With the bulging disc etc. Yet trying to say I have got any arthritis it's unbelievable. I'm in my late 40s. I hope u&everyone else has better luck than me. If the doctor sees this aswel maybe u can give me some advice. I am over weight have tried everything to lose weight too. So much more I could say but when u have this u have to makesure other things don't start going wrong aswel. I wish everyone good health as best as can be❤
I had a L5/S1 Grade 4 Spondylolisthesis after having a L4/L5 Laminectomy. I ended up with a ALIF, now after 20+ Years I am getting nerve pain after walking or standing for more that 10 minutes. Thank you for the explanations.
I need to... I think I will definitely not have this done... So many people still have pain even after or worse pain
Looks brutal
I was worried about whether I would be a good candidate for fusion since I mainly have leg pain rather than back pain. Thank you for this video!
Same as my husband. Trying to avoid a double fusion at 62 yrs old but his quality of life is really being impacted.
Am having pain in my right leg too.
Thanks a lot Dr Su for simplifying all the difficult terminologies that I have been faced with for over a year now. I had excruciating pains in my right and left legs in 2022. I also developed bilateral foot drop and lower legs muscle weakness leading to reduced range of motion. At some point, my hands lower extremities started becoming weak.
I was given steroid treatment and the pains disappeared. Strength returned to my hands and got better with physiotherapy. The foot drop on the right leg is gone while that of the left is getting better.
Recently, I observed that the muscles on the right leg are still weak- wobbly and doesn't support me standing properly. I had MRI of the Lumbar spine about 3 weeks ago which revealed L4,L5 and S1 stenosis with bilateral mild compression of neura foramina exiting roots.
At this stage, do you advise surgery or I should take medical decompression and continued physiotherapy.
I will appreciate your kind response.
I think you need to see a spine surgeon. You can make a zoom appointment with me at California orthopedics and spine
for a 60 yr old male who is very active, (golf, softball, ice hockey, working out), what procedure would you recommend of the 3 procedures with a 21mm spondi S1/L5 and an obliterated disc...no leg pain but every 4-5 months there is sore back usually from over working it....Love your videos and explanations...thanks
Did you get surgery
Dr. Su, you're videos have been the best, detailed information I've received so far! I was.diagmosed with bilateral pars interarticularis , grade 1-2 slippage spondylolisthesis at L5 almost 3 years ago. I don't have much back pain, but the butt and leg pain and numbness is excruciating at times. My pain is typically left buttock, hip, left outer calf and down into my ankle. My entire leg gets numb if I am overactive. I've had PT, and headed for my 3rd epidural soon. The neurosurgeon suggests ALIF. I'm 48 and used to be very active. Are the benefits of surgery better than the risks? Will I ever be able to be active/exercise without causing pain for months at a time? Will surgery fix that? I just can't imagine such a long recovery time and the possibility of still having pain.
You should watch the video on isthmic spondy
Dr. Brian, thank you so much for sharing. Would you have a comment or even share a video on interspinous implant devices to treat spondylosisthesis grade 1?
That's a complicated question. In general I would not recommend them as standalone fusion devices.
your videos explaining this condition and the options for treatment has really helped me a lot understanding my body and my options, I really apreciate them! I do have a question, I have this and because of the amount of pain I have my doctor has recommended surgery, sadly not going into much detail I cannot afford it now, but my pain is so much that i literally can't live a normal life and can barely walk. Some people have asked me if a cane could help and I think it would, since I feel less pain when walking and leaning on someone else. Would you recommend it? and if so what kind of cane or crutches should I use?
There are a lot of non-surgical options available in my video
Thank you for the very informative video!
I learned a lot as a physician ( another speciality).
Could you please post a video about Lumbar artificial disc replacement?
Thank you!
Yes I can do that.
I am still waiting for your video about Lumbar artificial disc replacement 🧐
Are bone density tests required? I’m 71 yr female.
Thank you so much for posting these videos…the explanations are extremely helpful and so much more thorough than what I received at my initial appointment. Spondylothesis L4/L5 and kyphosis mid back. I was released from PT with no relief in spondy symptoms….kyphosis symptoms improved. Was told to lift weights at a gym, swim and try Pilates. How long should I continue on this course? I’m managing the pain with two Aleve in the am and than endure the pain at night.
I would continue doing physical therapy indefinitely at home
Another very helpful video, thank you. My back has been in a lot of pain for a decade. Probably due to my excessive weight issues. I have seen several spine docs in the last 5 to 7 years. One doc recommended a decompression, however, most recently I would need a fusion L4,5. Additionally, it was suggested I get my weight below 250 lbs on a 5'9.5" body. At the time my weight was 306 and I am now down to ~260.
I just turned 67 in January and wonder if there is any hope. My quality of life now is very poor and consist of sleeping 8-10 hours, to get up and sit at my desk most of the day except litter box runs. Exercising is difficult since my back is in severe pain when walking more than ~ 100 feet.
I did get an inversion table and set it for ~ a 25° tilt. Enough to pull on my lower back but not enough to hurt my ankles/knees. It does feel good while on it and I do get some short term relief from the temporary decompression.
Question. At my present weight, should that be enough to keep me from going to surgery?
Oh, the diagnoses was a combination of spondylolisthesis L4,5, herniated disk at same location and a fair amount of facet arthritis at L4,5, S1
Is there any hope or will I spend the rest of my life in misery??
Also, have you done a comprehensive video on what post surgery patients should expect with regard to pain and how to navigate issues like going to the litter box, showering, SLEEPING and other real life issues?? IF not please consider doing one. Your knowledge as a physician is excellent but when we leave the horsepital, we have to negotiate life.
One last thing, do you offer a phone consolation, for a fee, if one can mail you a recent MRI disk?
THANK YOU for any advice.
You can make a zoom appointment with me by calling California orthopedics and spine
This is me I'm having the same issues exactly I have degenerative joint disease but I need help L 4 5 S 1 & facet joints and mod to severe stenosis to several areas of my spine an several bulging discs an dextroscolios
Great videos Doctor! I'm a 52 year old male, not overweight and have always been very active. Grade 1 spondylolisthesis L5/S1 with total collapse of disc. Appears to be pretty stable as it's basically bone on bone. 4 months into physical therapy which has been up and down. Numbness in right leg/foot but no significant loss of strength. Back and buttuck pain on left side. Question, can you do a laminectomy without fusion on a grade 1 spondylolisthesis? I'm spending half my work day resting on my home office floor and half oscillating back and forth between standing and sitting. Thanks
This sounds like you need a surgeon to look at the images. You cannot have a decompression only if it's an isthmic spondy. If you have a degenerative one it might be possible.
Any new procedures for Facet Syndrome in the Lumbar area? I am only 63, but I can only stand for maybe 3 minutes before my pain is so severe that I must either sit down or fall down. For this reason I feel that I am forced to use a Rollator Walker whenever I go out so that I have an emergency place to sit down. I have had two Neurosurgeons tell me that they can’t do anything for me. I would appreciate hearing your thoughts on this please.❤️❤️
I do not recommend surgery for lumbar facet syndrome. You should think about ablations.
My dear sir, I have been following you for a couple of years now. I have Spondylolisthesis only it's L3 L4 with Degenerative disk L5 S1. I also have Osteoporosis. I am seeing a Pain Management Doctor and have had my second round of shots. Before that the leg and buttock pain was 8 if not higher. After the first shots I was amazed. This second shots are good, but noticing a little sciatica in left leg and back is around pain level 4. Although I know surgery should always be a last resort, does a pain management doctor ever send you to a spine doctor?
Pain management doctors are the primary source of referral for us. Sounds like you might want to see a surgeon.
@@DrBrianSuTheSpineGuy Thank you so kindly 💖
Thank you so much for the thorough explanation!
I have been having pain in my right buttock and leg for six months now, but for the first five months, I thought I had Piriformis Syndrome until I took an MRI. Now I'm doing physical therapy using the Boot Camp Program for Lumbar Spinal Stenosis developed by Dr. Carlo Ammendolia (Mount Sinai Hospital in Toronto, Canada). One strange thing I have been experiencing is the noises my spine sometimes makes (like a small popping sound when one cracks a finger ) when I move around--- no pain associated with the noise. I am very sure they were not present before my condition started.
Any thoughts?
Have they checked for spinal fluid? Or the discs? Also u are more open to fractures aswel cos of it
Thank you for the extremely thorough and easy to understand options for spondylolisthesis. The neuro surgeon I saw says he will not pull the spine back in place, as it is more risky. What are your thoughts on that. I really do not want surgery. I have several inflammatory conditions that will likely cause some issues with more surgeries, foreign objects, etc. If the spine naturally fuses (you did not talk about this one) is there a way to go back in to give nerves more room? Would sacral rhizonomy help the buttock pain? Can you get the bone spacer without fusion? Thank you
The spacer cannot be put in without doing a fusion. In general trying to reduce it to look perfect is not necessary. Sometimes it can stretch the nerve too much. You should discuss it with your surgeon.
@@DrBrianSuTheSpineGuy thank you for your reply!
I wish I had seen your informative videos before I had the fusion for L4 L5 spondylolisthesis 17 years ago, which was drastic and so painful. I'm told that I now have spinal stenosis and learned today that I have an infection on L1 L2. Do you have any videos on this that I can learn from? Thank you.
An infection is a serious thing in the spine you should see a spine surgeon
I had a Laminectomy 2 years ago l3,4,5. Now an MRI show Spondylolithesis at l4 l5 with moderate diac height loss. Hoping I can avoid fusion. If not as I already had the Laminectomy would my surgeon just be likely to put in the rods and screws. Would this be co sidereal minimal surgery? I can't sit or stand for
more than 5 minutes. I hope to see the surgeon soon and your fabulous videos have given me lots to think about and questions to ask. Thank you!!
It would be hard for me to say without looking at the imaging. You can always get a second opinion by making a virtual appointment with me.
@@DrBrianSuTheSpineGuy thank you! I might just take you up on the consult. I saw the Dr. at the Spine center today and he ordered another injection. He was comfortable with taking the non surgical approach with PT meds and possibly a 3rd injection if needed. He is more concerned about the bulging disc between 4 and 5 than the spondyilithisis which apparently is minimal.
@@DrBrianSuTheSpineGuy I have my images and notes from my Xray and MRI. I will send you an email so I c an send them to you and we can go from there. Having had a Laminectomy is there still a chance to have the MILD surgery to relieve the nerve pain with a bulging disc L$/L5 and spondylolisthesis ? The injections did not work and the Dr. does not think and 3rd one would help. Looking forward to working with you and getting your opinions. I have an appt with the Surgeon on November 10th and feel I am well educated to ask all the right questions and thank you for that but want a 2nd opinion.
I am 59 and have this as a grade 1 with awful buttock pain and hamstring pain, it does wear off during day, I also have ddd
I’m opting for nerve block injections first but have been advised maybe an op
That was a great video, it explained in depth what I am about to have. All the symptoms are exactly what I have. Back pain, leg and hip pain etc. I have to say I am and am mot looking forward to the surgery because of all the after surgery down time but it sure will beat being in this constant pain I'm in now. Update, Has the surgery last Tuesday and stay in the Hosp. for a few days to monitor things then on 3rd day I really wanted out of there. no place to get rest for sure. Got home on Wednesday. Not going to lie I feel like I was run over by a bulldozer across the waist and back. Today has been the turning point, I'm not allowed do do anything and im at least able to get up and go to the bathroom on my own. Getting better every minute. Thank the Gods Old and new for pain killers!!
I am just healing from a 5,4, & 3rd lumbar fusion with decompression to the spine. I did my best to avoid this for 3 years. Then no more could be done. Can you share about healing process and changes with in the spine. Things to promote health of the spine and things to avoid. Thank for all your information.
Best Regards 😊
I had a laminectomy L2 -3 through L5-S1, four levels, about two and a half years ago. At the time my surgeon advised me that I had some slippage at the L4-5 level, but the decision was made to just do a decompression as it was less invasive than the fusion. Now I have developed a synovial cyst at that same level, and we are in the process of evaluating surgical options, to correct the slippage and also address the cyst.
Have you had any similar experience, and, if so, what was the outcome of that surgery?
As a background, I am the same age as your Mom when she had her surgery, seventy five. I am in good health, and physically have been active all my life, but the buttock and leg pain, as well as intermittent back pain has caused me to stop almost all activity.
Thank you for your videos! You make a very complex and confusing subject easier to understand.
Please watch the video on synovial cyst. You can also have a virtual appointment with me by calling 415-925-8200
Sir. I have lumber disc degenerative case since 2019 , my doctor find it there's two mark on my back bone one is on the middle and the other one is on waist through my MRI result, he prescribed me to take Pegabid ME75, Lupirtin, symbal and thioact D4, now I think that the middle one is find I don't feel any symtom, however some time the other one that's on my lower down of waist i feel pain, the symtom is also not same, sometimes the pain occur on left side, when left side is OK, start again on Right side.... So what suggestions can you do for me Doctor
Thank you for your very informative clip. I’m curious what is the percentage of people with degenerative Spondylolisthesis needing surgery? And is this the same percentage for someone with Isthmic spondylolithiasis needing surgery?
It's a good question and hard to know. Most patients with a degen spondy end up not needing surgery.
Thank you for your reply. When doing Consultation with spine surgeons there is so much information to take in, These clips help with processing the over load of information.
This is me. I've lost my lordosis, have spondylolisthesis at L 4-5, have had 4 previous discectomies. Now I'm looking at a 3 or 4 level fusion with spacers to correct my lordosis. This is the LAST time I'm ever having surgery!!
I'm 27, would you recommend a l4/5 fusion and fusion for c3/4 too?
Goodevening . What about artificial disc? Is better than the fusion? I understand that a lot of doctors are changing metodologia. Thank for the answer
Lumbar disc replacements have not popularized as much as cervical because of outcomes. You should watch the degenerative disc disease videos
Hello Dr. Su, I have L4 L5 DDD with moderate disk bulge. No problems with L5 S1. Question: How might an L4 L5 fusion affect the lumbar? Would ADR maybe better? Thank You for Your Work.
There is a risk of adjacent level disease which comes both with disc replacement and fusion
Dr Su what about doing an OLIF for l4/5 spondy with bilateral nerve compression and stenosis? Been to YEARS of PT, Medial Branch Blocks, RFA, Transforaminal Epidural, SIJ injection etc and 1 hip replaced years ago. My concern is getting an accurate diagnosis as Multi level pain with buttock, leg, knee into ankle foot and toes and when hip was replaced finally found out about HSD/HEDS. Now have gluacoma (steroids?) so further injections not an option. Thank you.
Olif is very similar to an alif and in my mind and alif is much better in terms of disc preparation and visualization. Olif is a good option if your surgeon is very familiar with it.
Hi, I am a bit younger and would like to prevent spine issues. Can you make a video on preventative care tips for the spine? Thanks!
What is the best approach in general for l5 s1 DDD? Dr suggest 360 fusion. What do you think about artificial disks new generation, also what do you think about the stand alone fusion? Thanks
Watch the degen disc disease playlist.
Thanks for the video. I have a better understanding now. I do have a question. On my last mri, the radiologist wrote fusions noted along my lower back. Is this possible? I never had surgery. I only have injections and 3 epidural. Can my back fuse on its own? I do have spondylitis, Radiculopathy, and stenosis from the L4-S1
Yes bones can fuse by themselves.
Question-In 2009, I had Spondylolisthesis with fusions, plus Limectomy S1-L5. Now have 2mm Spondylolisthesis L5-L4 with 2 bulging discs above. Also, 2 of the pedicle screws are butted up against the Iliac veins. Afraid if I need surgery, the 2 levels above will need it down the road. What do you suggest?
I would have to look at the imaging. You can make a virtual appointment with me at California orthopedics and spine
Would be interesting although maybe a bit off topic (not sure) to hear your opinion on non “screws-and-metal” techniques for treating bones and discs such as stem cells which have recently appeared in recent interviews! The Mel Gibson interview, and others…
I will work on those.
@@DrBrianSuTheSpineGuy great work by the way ❤️ ur videos!!
Hi Dr Su. My mom has been suffering from severe back pain for over half a year. She’s taking 2x a day pregabalin, plus Arcoxia as needed. She has L4-5 degenerative spondylolisthesis plus facet joint hypertrophy, and neural foraminal compromise at the same levels. She is really scared to do fusion given her age 72yo and her osteopenia. Is decompression alone sufficient? We are willing to gamble on decompression alone but are also worried of having to do fusion eventually. Been contemplating this for over 4 months now. Thank you Dr.
I would have to look at the imaging. You can call California orthopedics and spine and make a virtual appointment with me
Thank you Doctor. I will do that. :)
Are their any new alternative procedures instead of fusion?
I am 73 and MRI says I have extensive spondylotic changes with spinal stenosis in regards to my lumbar spine. I also have degenerative disc disease. I am doing physiotherapy and don't want to do surgery. Could I have your opinion. I thank you for your great videos.
You can make a virtual appointment with me at California orthopedics and spine
Question: Is it likely that the pain from a very arthrotic facet joint is also reduced as "positive" side effect if a fusion is done (because of radiating pain and instable degenerative spondylolisthesis) ? Your videos are the best!
There is some evidence to suggest that fusion can help pain from the facet but that is not a primary reason to do the fusion. It is an added bonus.
Hi Doctor Su, I was diagnosed with spondyloisthesis two year ago. I’ve been having low back pains for 10 years. Is it possible to do surgery and not remove the discs? The structure of my discs is okay but my problem is the alignment.
Back pain itself can come from many things you may want to watch the lumbar facet video which can cause pain in the setting of spondylolisthesis.
Can spinal stenosis caused by degenerative lumbar spondylolisthesis be reversed by surgery?
Hay Kathy
Recently discovered that I have at level L4-5 advanced spinal stenosis,disc degeneration,facet atrophy and grade 1 anterolisthesis but other then mild leg weakness I have no pain or disability.Should I consider surgery or wait for till my symptoms progress.
You should watch the non-operative treatment and surgical treatment videos
Could i start training again, i am training kayak slalom, and would screw be in me forever
Iam 48 years and got diagnosed with C5-C6 Degenerated Disc, Concentric/Lt posterolatersl disc protrusion indenting ventral subarachnoid space and encroaching upon Lt nerve c root. Would surgery considered a must? Thanks
Watch the cervical stenosis videos
I have been struggling with spondylolisthesis since 2011-12 and I?ve taken lot conservative management but now things are getting worse day by day and I?m 25 years old and two surgeons told me to go for surgery. Ive been taking meds physio all the measures and now being honest i have days where i cant take it anymore feels like quitting and im so confused and dont know what next step should be taken as of now dealing with both cervical and back pain is being painful. These were my findings in my MRI
Disc osteophyte complex is seen at C 3-C4, C4-C5 and C5-C6 levels.
There is indentation of thecal sac as well as cord at C4-C5 level however no obvious altered signal is seen in the cord.
Disc desiccation at L 4-L5 and L5-S1 levels.
Mild diffuse disc bulge at L3-L4 level indenting the thecal sac causing mild narrowing of bilateral neural recesses.
Diffuse disc bulge with focal central protrusion at L4-L5 level indenting the thecal sac causing narrowing of bilateral neural recesses.
Mild anterolisthesis of L5-S1 vertebra with diffuse disc bulge at L5-S1 level indenting the thecal sac causing narrowing of bilateral neural recesses and abutting bilateral exiting nerve roots. A small posterior annular tear is seen at this level.
I would like to know what should I do and recently there is so much numbness and a lot of cramp pains.
You can call 415-925-8200 for a virtual video appointment
Can the bone removed during a Hemilaminectomy grow back over time? I had one 8 yrs ago and pain has recently gotten worse and the Hemilaminectomy isn't noted on my current mri.
No usually it does not
Hello dr Im in so much pain with a grade 1 spondylolthesis, I have recently had a nerve root block injected but it has not touched me or helped at all. Im in agony and am told I need surgery im scared im only 36)
What if you are not well enough to go through a 5 hr surgery. I have Pots and chronic fatigue from late stage lyme. I have spinal stenosis, slight scoliosis and a disc that is slipped. The area involved is L5 and S1. My pain is everyday and I can barely walk.
Do you treat people from out of state?
You can make a virtual appointment by calling California orthopedics and spine
If you have a spoon Lo due to failed fusion and lamenectomy in the early 80s what would you suggest for treatment. I am now dealing with severe foot pain numbness and now cramping
I would have to look at the imaging you can make a virtual appointment by calling California orthopedics and spine
how much range of motion would you estimate a person will lose for a L5 S1 fusion for par’s defect on both sides?
You would not lose any motion that you would perceive. There might be some micromotion loss that translates some load to the l45 level but you would not feel stiff
Can discs be preserved and injected with prp?
I'll do it an episode on that. PRP is only good for black disc disease
I have no arch in my back, it's straight. I'm an avid weight lifter just to work out some, I can't stay bent over to long because of the pain, I'm wondering what type of life will I have if I do the surgery.
It depends on what the issue is you should see a spine doctor
What do you know about the miner man
Hello Wilma
Ho. I Live in Neaples.. next friday i will have i tlif l4-l5 For a spondilolhistesis grade 1, And a bilater builging. I have not Back pain ; but both legs pain since 3 month, And parestesismsince 6 weeks. I did much terapy, but no result😢. As I start to walk, i have sinthom. I am 56 years old, And very fit tennis player . Will this surgery let me to’ play again?’ How long recovery? Thanks
For the most part, my pain runs down the outer left side of the thigh only and the left side of the tailbone. Most people have pain down the back of the leg. Why is mine different?
The other part of the leg could certainly be The l4 l3 nerve
If I get a fusion at L4,L5 will I be able to train at my Karate dojo in 6 months or so? I am 68. I teach Karate in Tokyo Japan. Of course I would avoid training to hard, but I am hoping to be able to still kick. My teacher is 82, and he is still training.
Yes there are no limitations after you fuse