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Dr. Hanson
Dr. Hanson, Doctor (MD)
Category: Health
Satisfied Customers: 935
Experience:  Diplomate, American Board of Quality Assurance & Utilization Review Physicians
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Can an untreated herniated disc cause a spondylolisthesis later on

Resolved Question:

I herniated a disc 9 years ago with a very bad fall and have suffered with back pain ever since that fall, original MRI's only shoed the herniated dsc at L4-5 now 9 years later as my back pain has become increasingly worse a new MRI and x-ray show not only that I only have 4 lumbar vertabrae, but I nw have a spondylolosthesis at L 3 with arthritis only shown in the area of original injury. This was a work related injury 9 years ago (i am a police officer injured arresting a burglar) and now that a Ortho Doc says I need surgery, My PD does not want to approve the surgery telling me this is a degenerative condition that had nothing to do with the original injury. I am finding that hard to believe. I believe they are correct that it is degenerative, but I believe it had to be the result of the original injury since that is when all of my pain began.
I also wonder if it is possible that I started out with an undetected spondylothesis?
See my back pain becam very bad 2 yesrs ago immediately following my hysterectomy and I just wonder if it is possible that my constant inflamed uterous and flapian tubes could have been holding the vertabrae in place? i know this is far fetched, but it just seems too coincidental and almost possible.
Submitted: 7 years ago.
Category: Health
Expert:  Dr. Hanson replied 7 years ago.

Your original MRI didn't show arthritic changes in your facet joints ("original MRI's only shoed the herniated dsc at L4-5"). You had an L4-5 herniated disc 9 years ago. A herniated L4-5 disc (between the L4 and L5 vertebrae) would impinge upon the L5, S1 nerve roots which would cause axial (mechanical) pain and parasthesias in your back and lower extremities. Even though it's common for discs to flatten and weaken with wear and tear (which, if you think about it, is "trauma") over a period of time which leads to instability in the movement of the disc (micromotion); however, your original MRI didn't show flat discs---it showed a herniated disc at the L4-5 verteba.

Imagine you're making a stack of ice cream sandwiches. You take 5 graham crackers and in-between the graham crackers you place a scoop of vanilla ice cream. Now, imagine that you press on the 4th graham cracker. The vanilla ice cream extrudes (ruptures) AND the 4th graham cracker is closer to the 5th graham cracker. What happens to the 3rd graham cracker? That's right, it slips because its support (the L4-5 vanilla ice cream/disc ruptured). This is what has happened to your discs. Had you never had an L4-5 herniated disc 9 years ago, then your L3 disc would not have slipped. (" I nw have a spondylolosthesis at L 3 with arthritis only shown in the area of original injury.") Spondylolisthesis is disc slippage caused by instability from trauma to the facet joints. "Degenerative" spondylolilisthesis usually involves the L4 disc---your spondylolisthesis is at the L3 disc, not L4. The body tries to restabilize the disc by enlarging the facet joints. This pinches the nerve roots and produces pain and parasthesias. Acquired spondylolisthesis can be caused by a single or repeated force being applied to the spine; for example, the impact of falling and landing on your feet.

You have spondylolisthesis due to a fall.

Customer: replied 7 years ago.
Reply to Dr. Hanson's Post: I probably sould have been more clear that the new docor realized I had been mis diagnosed with and l4-5 5 herniation because I was born with only 4 lumbar vertabre so the actual herniation was at 3-4 and I now have am L-3 spondylolthesis. Also you did not address whether my female organs could have been holding this vertebrae in place all this time or if it's just your opinion that because of the original herniation I have developed this spondylolisthesis.
Also your last commentabout falling and landing on your feet came from www.spineuniverse.com, I did do my own research before askinfg this question, but I could not find anywhere, where spondylolisthesis could develop over a period of time after a disc herniation or if it would of had to have happened at the same time as the herniation.
Expert:  Dr. Hanson replied 7 years ago.

Your spondylolisthesis is due to your fall, as I said previously. You had no abnormal findings on your original MRI except for the disc herniation. You don't mention that you have arthritis in any other areas of your body which, if your arthritic changes are due to the normal aging process would likely show up as osteoarthritis elsewhere in your body e.g. in your hips, cervical spine, shoulders, etc. I don't believe it's a coincidence that you would have arthritic changes due to normal aging specifically localized to the area of your original injury unless the injury caused the degenerative changes. Spondylolisthesis is a side effect of a ruptured disc. It makes no difference whether you have 4, 5, or 6 lumbar vertebrae, you can have a ruptured disc if you fall from a rooftop or from a ladder. Of course, the further you fall, then the more likely you are you will rupture a disc. When a disc is ruptured then it affects the stability of the vertebra above it (graham cracker/ice cream example).

Your slipped disc could not be due to your hysterectomy.The vertebrae are not held-up by the uterus. The vertebral column is held in alignment by ligaments which have nothing to do with the uterus. Removal of the uterus does not cause spondylolisthesis (slipped discs). On the other hand, many women who have hysterectomies complain of back pain: In one study 51.9% of women who had their uterus removed (with or without removal of their ovaries) complained of back pain as an adverse outcome following surgery http://www.hersfoundation.com/effects.html#chart4. Here are links to diagrams showing the relationship of the sacral spine to the female reproductive organs:

http://hon.nucleusinc.com/enlargeexhibit.php?ID=7343

http://hon.nucleusinc.com/enlargeexhibit.php?ID=221

Spondylolisthesis can occur weeks after the initial injury or years after the initial injury depending upon several variables e.g. the stability of your spine prior to the accident, your activity level following the accident, your posture, your weight, the extent of the original deformity, the condition of your vertebrae before the accident, the progression of the disc rupture, the degree of tilt of the vertebrae, etc., etc.

Fusion is the usual treatment to prevent your spondylolisthesis from progressing and to eliminate any abnormal motion as a result of your spondylolisthesis.

Dr. Hanson, Doctor (MD)
Category: Health
Satisfied Customers: 935
Experience: Diplomate, American Board of Quality Assurance & Utilization Review Physicians
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