Spondylolisthesis and stenosis

In this video, Dr. Castanet will show you the lumbar MRI scan of a patient with spondylolisthesis and stenosis at L4-5. The remainder of his spine looks good. This patient had a history of low back and leg pain for many years. Sometimes his pain would go away for a long time, then it might recur and be incapacitating for several days. He just didn’t understand the problem and why it would vary so widely from fine to disabling.

There are several points to be made about his pathology. First, spondylolisthesis is a slowly progressive degenerative problem. It can vary widely in the severity of symptoms as his has. This is an example of how important it is to explain the problem to patients so that they are not anxious and lost in their problem. Every patient should be explained, what is the problem, what is the natural history of the problem, what to expect going forward, is it a dangerous problem, what are my present and future treatment options, when should they do which treatment, what is bad treatment, is surgery a present or future option or necessity, who should I see and trust to competently and effectively treat them. And, now and in the future, when they cannot remember the particulars, can they can me and consult with me about all these details again.

In the case of spondylolisthesis, i.e. slippage of the spine, one vertebra slips forward on another, usually because of degeneration and deformity of the bones. This is fairly common in older persons, and it tends to be slowly progressive, so that one day it may require surgery. But you need to see a speciality surgeon who will do this in the least invasive way possible.

This problem also results in narrowing, i.e. stenosis at the same level, and it is this narrowing that pinches the nerves in the spinal canal and causes pain down the buttocks and thighs, and legs.

I have treated this problem for 35 years, and when it is not too severe, most people will improve from my spinal decompression treatment. When it is too severe, I’ll get you to the right neurosurgeon for the most effective, least invasive surgery possible.

If I can help you with your neck or back problem, please call me at 404-558-4015. I’m Dr. Craig Castanet in Decatur, Georgia.