I’ve had a patient for several months now who illustrates a very common situation. She is a charming 72-year-old woman who retired to Ocala to play golf with her husband every day. For the first few years everything was fine. But over the past year she noticed that she was having more and more trouble walking the course. Whenever she tried to walk too much, her back would begin to hurt, and then the pain would spread down her legs. If she sat down, the pain would go away. It got slowly worse over the months, to the point where she started giving up golf. That just wouldn’t do!
My examination in the office revealed nothing out of the ordinary. But when I got x-rays of her back, the problem was evident. She had a lot of arthritis in her back. Over the years, the wear-and-tear type of arthritis had allowed some of the vertebrae to slip out of place with respect to each other. This is a condition called spondylolisthesis, which is Latin for “slippage of the spine.” The slippage itself can be painful, but the main problem it causes is pinching of the nerves in the spinal canal. This happens because the slippage causes a kink in the canal. Think of a rope passing through two rings. If the rings are lined up, the rope passes smoothly. If the rings get pulled out of alignment, the rope gets caught between them. My patient’s nerves were the rope, and the rings were her vertebrae. The pinching itself is called spinal stenosis. After I explained the problem to her, we began the usual conservative treatment. I started her on an anti-inflammatory medicine. I also sent her to physical therapy to strengthen her back muscles and improve her endurance. We tried this for about six weeks, and it helped, but not enough to get her back to golf. The next step was a referral to a pain management doctor for a shot of cortisone into her back. She had a series of three shots, and fortunately, she responded very well to them. Her pain cleared up and she was able to walk the golf course, if perhaps a little more slowly than before.
Probably about 50% of patients with this problem are able to keep their pain under control with conservative treatment just like my golfer’s. About 50% of patients don’t respond. Their problem may be just too far gone. For these patients there is still hope, but it does involve an operation. In a procedure called a “laminectomy and fusion”, I remove the bone spurs that are pinching the nerves, and then place some bone between the slipped vertebrae to stop the slippage. This works about 80% of the time to relieve the pain, and takes about three months to recover from.