Conservative Treatments

So, there I was after a couple of months of PT, and I wasn't seeing any real improvement.  While I was developing some better glute strength and coordination, there really wasn't any change to the pain levels down my leg, and the numbness wasn't changed by the PT.

At this point, I began to return to my CrossFit routine with modifications for weight and certain irritating movements like situps, T2B, etc.  I worked with a top-notch CrossFit instructor who helped me continue to develop my core strength and groove excellent lifting technique so as to minimize chances of injury and ensure a rock solid midline through all my WOD movements.  I was still in pain after WOD's, and when walking/standing for extended periods, but dealing with it.  In the later fall, I also spent about 10-12 sessions with a chiropractor doing decompression/traction on a special decompression table, as well as some basic lumbar adjustments, but that yielded little benefit in terms of pain reduction as well.  Towards the end of the year, when the pain really started to eat away me, I decided to return to my doc to see what he recommended as a next step.

My doc suggested that I could try an epidural spinal injection over the L5 nerve root to see if that would help, and after researching it online and weighing the risk/benefit, I decided to give it a try.  Since my ESI was going to be placed outside the spinal canal under x-ray fluoroscopy, and not near the spinal cord/dura, I figured it would be relatively low risk.  I went ahead and scheduled an ESI for late December.

On the day of my injection, I was taken into the treatment room and placed prone on a table, where the doc proceeded to position the x-ray scope over the lumbar area.  He then numbed up the injection spot and inserted the needle carefully and incrementally until he was directly over the nerve root. Of course, it hurt like hell when the needle made contact with the nerve, but within a few seconds of the anesthetic and medication going in, the nerve calmed down and I felt a delicious numbness wash down my leg as the pain went away.  After the procedure was over I went to stand up off of the table, and I discovered that my left glute was a bit numb from the anesthetic, which made my first couple of steps rather interesting.  But I left the clinic feeling pretty good and mostly pain-free.  I was told to take it easy for a few days to let the nerve heal and not irritate it, and then go from there.

For the first couple of days, I was feeling quite good and had much lower levels of pain, though the pain was certainly not gone, and I still had a bit of numbness.  I followed the instructions and took it easy for a few days before starting up again with some basic PT type work.  Overall, I was feeling pretty good for the first couple of weeks.  I wasn't doing any heavy duty workouts or CrossFit - just core work and some pullups and pushups, with an occasional Turkish Getup thrown in for good measure.

By the third week, the pain and cramping sensation began to return and by the end of a month I was more or less back to where I started.  At this point, I began to look for surgeons to discuss my situation with, and in the meantime started a few Pilates classes as well to see if they would help (they didn't).

During February and March of 2014, I met with two well-respected orthopedic spine surgeons in the area to get their opinions of my case.  The first surgeon reviewed my images and symptoms and told me that he would want to perform a spinal fusion of L5 on S1, and would cut me open from the side or from the front (ALIF procedure) and that I should never lift weights again (LOL).  The 2nd surgeon, who I really liked, also said that a spinal fusion was my best bet and that I'd be back to my activities in a few months after recovery, though I should seriously think about giving up weight lifting and take up running, etc. (also, LOL, considering how many injuries running can lead to as well).  He said he would go in from the back (TLIF procedure) and that I should recover fine.

Through my own research on the topic of spondylolisthesis, I have come to understand that fusion is considered the "gold standard" surgical treatment of the condition, but I have also come to understand (and the 2nd surgeon was quite honest about this) that fusion introduces new risks to other segments of the spine above the fusion location.  With the kind of active lifestyle I prefer to lead, this concerned me greatly.  Clearly, there is a tradeoff to consider here, and at this point I was not quite ready to "start the clock" on that adjacent disk degeneration.

Given the various factors and risks, and also including the significant recovery time and activity restrictions after a fusion, not to mention the downtime from work, I decided to put off considering a surgical option and continue to find ways to reduce the pain through conservative means.  I got back on my mobility and core work, continued doing decompression using my decompression device, and went back to working out and playing sports, trying to manage the pain as best I could.

In the spring of last year, I also went through a 7 week course of acupuncture, in the hope that it could trick the nerve into not feeling the pain.  Although I found acupuncture quite relaxing, ultimately it failed to have any effect on the nerve pain and numbness.

Through early summer of 2014, I continued to suffer from significant pain and numbness and it definitely began to affect my workouts and sports more and more, adding to my frustration and despair.  I decided to go through an additional injection in mid summer but it offered little lasting benefit.  Ultimately, since my nerve compression was anatomical in nature, injections and other conservative measures were unlikely to relieve pressure on the nerve due to the simple fact that the opening was simply too small and bone fragments were pressing on it.  Thus, there could be no real healing of the nerve.

Next: A new option

#crossfit #weightlifting #spondylolisthesis