Spondylolisthesis

[Melissa Tiessen]

Hi everyone, I have another case to share, the key question with this one is about spondylolisthesis. The client is a mid 30’s male, married, 2 young children. As noted in the summary which follows, he has a range of symptoms, along with lots of evidence of neuroplastic processes. He is struggling a bit however with the recent diagnosis of spondylolisthesis, at least in regards to his lower back pain. He can ignore the ‘mild degenerative’ findings for his cervical and thoracic pain, but is having a harder time making sense of the ‘moderate to severe’ findings from the recent lumbar MRI. Given that I don’t know enough about how the symptoms of spondylolisthesis would normally present, we would both benefit from any more informed perspectives. Thanks so much!

His description of his symptoms:

Neck pain – base of skull, to behind and above my eye. Above and below eyebrow.
(nausea, heaviness and tingling on the side of my head)
(fogginess, trouble concentrating)
(ear/nose feels clogged sometimes, jaw tightness)
(tightness runs down both sides of neck, to traps and above shoulders)

Middle Back – between shoulder blades and slightly above and below
(pinching pain, sometimes sharp pain and painful spasms occur)
(lots of tightness)
(I have pain that I believe wraps around my back to the front, just below the rib
cage, it makes it hard to breathe sometimes, and becomes very tight, right around the
diaphragm)

Low back – Left side hip I had a very painful spasm in 2019
(mostly left side, but sometimes the pain is in the middle or right side)
(feels like weakness, and pinching mostly)
(i feel it a lot when i lay down, or stretch out)
(Lots of tightness in my hamstrings and cafs)
(My QL muscles are also sore to touch, and are very tight most days)

I’ve also been diagnosed with IBS. I had a gastroscopy that came back “normal”.
I’ve always noticed that my stomach and neck seem to act up at the same time.

Dry eyes – I have chronic dry eyes from when I was a teenager, it was hard to wear contacts.
I was diagnosed with Meibomian Gland Dysfunction – and i’ve often wondered if my dry eyes,
and strain cause a few of my other issues- Neck related pains

Also history of tension or migraine headaches, dizziness, depression and anxiety.

Does not endorse any significant childhood events but multiple challenging adult experiences, including illness and death in family, work difficulties, financial stress, and particularly trying to manage Covid with two young children, one born with health issues.

Multiple relevant personality traits, including high expectations, conscientious, hard on self, overly responsible, frequent worry, wanting to be good/liked, being a rule-follower, difficulty letting go, tending to hold in thoughts and feelings, having rage or resentment, low self-esteem, putting others’ needs first, feeling sad, and hypervigilance.

Provocative testing – relief from pain when applied firm pressure to lower back.

Symptoms show evidence of being functional (i.e., pain in areas of old injuries, spread to other areas of the body, new symptoms pop up), inconsistent (i.e., pain shifts to different locations, symptoms occur after but not during activities, symptoms are impacted by thoughts), and triggered (i.e., symptoms triggered by anxiety).

Assessments/treatments:

Bloodwork
November 2021 – all normal (except for low MCH and high Ferritin – but both very close to ends of normal)
March 2022 – normal

Xray cervical and thoracic spine
November 2022 – degenerative disc changes at C5-C6, milder changes at C4-C5, mild scoliosis of the thoracic spine and mildly increased kyphosis of the upper thoracic spine

MRI cervical and thoracic spine
November 2022 – small T9-T10 left paracentral disc herniation without stenosis or nerve root compression

MRI lumbar spine
August 2023 – moderate to severe bilateral neural foraminal stenosis at L5-S1 which is predominantly the result of spondylolisthesis (grade 1)

Detailed MRI Results:

Impression

Two-level degenerative change as described. At the L5-S1 level there
is moderate to severe bilateral neural foraminal stenosis which is predominantly
the result of spondylolisthesis and minimal generalized disc bulge. At no level
is there any significant central canal stenosis.

Narrative

INDICATION: L5-S1 radiculopathy.

TECHNIQUE: Routine MRI Lumbar Spine.

FINDINGS:

There are 5 lumbar type vertebrae.

There is grade 1 (8mm) spondylolisthesis of L5 on S1. There is also bilateral
spondylolysis of L5. This is better seen on CT scan. The spondylolysis is
predominantly on the basis of degenerative change but partially on the basis of
bilateral spondylolysis.

Vertebral bodies are otherwise intact and the alignment is otherwise normal.
Conus is at the L1 level. Distal spinal cord is normal.

At the L4-5 level there is a minimal generalized disc bulge. There is mild
bilateral facet osteophytes. There is mild bilateral neural foraminal stenosis.
No central canal stenosis.

At the L5-S1 level there is spondylolisthesis with unroofing of intravertebral
disc. There is minimal additional generalized disc bulge. This combination
results in moderate to severe bilateral neural foraminal stenosis. There is no
central canal stenosis.

The upper disc levels are normal with normal disc hydration and no disc bulge or
protrusion.

There is no paravertebral soft tissue mass.

[Author]

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