AboutJ. Shawn Leatherman, DC, CCST, CCSP Expertise I can answer questions on general chiropractic care, sports injury, whiplash and auto crash, mild traumatic brain injury, structural and functional rehabilitation of the spine, nutrition for inflammation and repair, fitness training, nutrition for sports performance and other general health and nutrition related inquiries. I currently lecture on automobile trauma, occupant kinematics, and forensic risk analysis to local EMS, Fire and Police, as well as nutrition and sports injury to community groups. Rest assured all answers are generated from my clinical experience, and scientific research.
Experience I have accumulated over 1000 hours of post-doctoral training to include; Certifications in Spinal Trauma and Mild Traumatic Brain Injury from the Spine Research Institute of San Diego and the International Chiropractic Association, Certification in Low Speed Auto Crash Reconstruction and Certification in Forensic Risk Analysis from The Center for Research Into Automotive Safety and Health, Certified Proficiency in spinal and extremity diagnostic proceedures from The Motion Palpation Institute, Certified in Sports Injury and Rehabilitation from the National University of Health Sciences and The American Chiropractic Board of Sports Physicians, Nationally Certified Fellow of Structural Rehabilitation from The Chiropractic Biophysics Organization, and I have advanced training in manipulation under anesthesia and nutrition. Feel free to check out my website: www.suncoasthealthcare.net
Organizations International Chiropractic Association, Florida Chiropractic Association, American Academy of Pain Management, Chiropractic Biophysics, Spine Research Institute of San Diego, Center for Research Into Automotive Safety and Health, Motion Palpation Organization, American Academy of Manual and Physical Medicine, Fort Walton Beach Chamber of Commerce, The Better Business Bureau
Education/Credentials B.A. (Psychology) from The University of Cincinnati, B.S. (Human Biology)& D.C. (Doctor of Chiropractic) from Cleveland Chiropractic College, C.C.S.T. (Certification in Chiropractic Spinal Trauma) from The International Chiropractic Association, C.C.S.P. (Certified Chiropractic Sports Physician) from The American Chiropractic Board of Sports Physicians.
Question I was involved in a auto accident in April 2009 and a few days later began experiencing chronic back pain/pain down my leg when sleeping and when sitting and crossing my legs.
I have been in engaged in physical therapy 2x w week since may; this has helped the overall back pain but not the leg radiculopathy. An x-ray taken showed I had spondylolysis but I had never been bother by any back pain or problems prior to the accident (my foot and arm were injured also).
The MRI findings:
There is an exaggeration of the normal lumbar lordosis/ L5 spondylolysis is demonstrated. There is a 1.8cm antereolisthesis of L5 on S1 with approximately 60% anterior displacement of the L5 vertebral body.
At the T12-L1 interverebral disc level, there is a mild decrease of disc heigt, disc desiccation, annular bulge, and a small posterior osteophyte formation seen. Mile facet hypertrophy amd hypertrophy of the ligamentum flavum are demonstratted. There is a mile bilateral recess narrowing.
At L1-L2, L2-L3, and L3-L4 intervertebral disc leveks, here is facet hyertropy and mild hypertrophy of the ligmentum flavum with associated bilateral lateral recess narrowing.
At L4-L5 intervertebral disc level, there is annular bulge, marked facet arthropathy and hypertrophy of the ligmentum flavum, There is moderate bilateral recess narrowing seen. Mild right sided neural foraminal narrowing is demonstrated,
At L-%-S1 intervertebral disc level, here is significant decrease of disc height, endplate changes, osteophyte formation, and facet hypertropy noted.
You have quite a bit of degenerative issues on this MRI which predate the injury and could have been easily aggravated and exacerbated by the trauma.
Of concern is the disc bulging with moderate bilateral recess narrowing seen at L4 / L5 and right sided neural foraminal narrowing...this can cause pain radiating down the right leg and can be the result of the crash. Moreover, the initial finding of the MRI is not good (There is a 1.8cm anterolisthesis of L5 on S1 with approximately 60% anterior displacement of the L5 vertebral body) This is called spondylolysis because the posterior aspect of the vertebra has fractured away from the anterior portion of the vertebral body. Now this is an important finding because the L5 vertebra moves forward and 60% of displacement would be considered a Myerding Grade 3 classification....additionally there are 4 types of spondylolisthesis...the dysplastic and pathologic are less common, so I will explain the Isthmic and Degenerative types.
Isthmic spondylolisthesis is the most common form of spondylolisthesis...also called spondylolytic spondylolisthesis. Reported prevalence is around 5%-7% in the U.S. population. Fredrickson, et al. demonstrated that the defect is usually acquired between the ages of 6 and 16 years, and that the slip (forward displacement) often occurs shortly thereafter. Once the slip has occurred, it rarely continues to progress, although one study did find an association between disc desiccation (loss of hydration content in the disc or degeneration) and slip progression during middle age. One very long-term prospective study by Fredrickson, et al. that followed 22 patients from the development of their slip into middle age, reported that many of the patients experienced occasional back pain, but so does the vast majority of people without isthmic spondylolisthesis. One patient did undergo spinal fusion at the slipped level, but the study could not verify if the isthmic slip was the indication for surgery. Roughly 90% of isthmic slips are low-grade(less than 50% slip) and 10% are high-grade (greater than 50% slip)such as your case.
The most common grading system for spondylolisthesis is the Meyerding grading system for severity of slip. The system categorizes severity based upon measurements on lateral X-ray of the distance from the posterior edge of the superior vertebral body to the posterior edge of the adjacent inferior vertebral body. This distance is then reported as a percentage of the total superior vertebral body length:
* Grade 1 is 0–25%
* Grade 2 is 25–50%
* Grade 3 is 50–75%
* Grade 4 is 75–100%
* Over 100% is Spondyloptosis, when the vertebra completely falls off the below bone.
Degenerative spondylolisthesis is a disease of the older adult that develops as a result of facet arthritis and facet remodeling (degeneration of the spinal joints). As the facets remodel, they take on a more sagittal orientation (front to back), allowing a mild slip to occur. These slips are very common: a study of osteoporosis found a 30% incidence among Caucasian women older than 65 years and a 60% incidence among African-American women older than 65 years. So this could have easily been there before the crash occured...and exacerbated by the trauma.
Prognosis will depend on the amount of neurological compromise you are experiencing. Neurogenic claudication is a common "presentation", or possible symptom of compression or inflammation of the nerves emanating from the spinal cord. Neurogenic means that the problem originates with a problem at a nerve, and claudication, from the Latin for limp, means that the patients feels a painful cramping and/or weakness. this can occur either bilaterally or unilateral in the calf, buttock, orthiggh with associated pain and/or weakness. In some patients, it is precipitated by walking and prolonged standing. The pain is classically relieved by a change in position or flexion of the waist (forward bending) and not simply relieved by rest. The pathophysiology is thought to be ischemia (lack of oxygenation to the nerve tissue of the lumbosacral spine secondary to compression from surrounding structures.
These cases can sometimes be non surgically decompressed with the aid of traction devices, while others need surgical stabilization. Stabilization techniques from surgery have been reported in the literature to have favorable outcomes in follow-up studies, but those facts would need to be addressed by a neurosurgeon.
Hope this helps Dee...I know it is a bit complicated. I have a more succinct and simpler answer on my website in the glossary section...just look up spondylolisthesis.
Respectfully,
Dr. J. Shawn Leatherman
www.suncoastehalthcare.net
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