Spondy Surgery - Latest Research

Hi spondy athletes.  I came across some recent research and case studies discussing surgical approaches for isthmic spondylolisthesis and thought I would share with you all.  Here are the studies I thought were interesting:

1) This study from 2020 looked at using endoscopic decompression surgery alone (without fusion) for adults with isthmic spondylolisthesis and found the results to be successful.  The study was very small and only looked at 2 adults, but the conclusion is still very encouraging.  

"Conclusion: For patients with spondylolisthesis-associated low back and leg pain without spinal instability, TFELD is a safe and effective surgical treatment option."

2) This case study: "Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis"

3) This case study: "An Elite Triathlete with High-grade Isthmic Spondylolisthesis Treated by Lumbar Decompression Surgery without Fusion"

4) This study from 2016 performed a systematic review across many other studies to evaluate the outcomes of using various treatment approaches for different types of spondy, including conservative management, surgery with decompression and fusion, and surgery with decompression alone (no fusion).

"Surgery appears to be better than conservative treatment in adults with isthmic SL (poor evidence) and also in adults with degenerative SL (good evidence). Instrumented fusion with decompression appears to be more successful than decompression alone in adults with degenerative SL and spinal stenosis (poor evidence)."

It seems that for those with isthmic spondy, surgery has some evidence of being better than conservative management, but that the evidence was "poor", and that fusion has some evidence of being better than decompression alone for degenerative spondy but that the evidence is also "poor".  It appears they didn't study fusion vs. decompression alone in isthmic spondy, and I can't find much in the literature that does larger comparisons either, unfortunately.

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Overall, in general, fusion still seems to be the "gold standard" for unstable or higher grade spondylolisthesis, but for low grade and stable spondy, it is very interesting and encouraging to see the evolution of medical thinking from what was considered the only surgical approach (fusion) to an approach that only uses decompression to free trapped nerves.  Obviously the above cases in bullets 1-3 represent small data sets and not large scale studies, but to know that successful outcomes and return to function are possible and effective for those without instability due to their spondy using decompression alone is great news for those trying to navigate their way through potential treatment options.

Hope this info is useful!

#crossfit #weightlifting #spondylolisthesis

Into 2021

Hi readers.  Just a quick note to say I'm still here in 2021, and still training.  

Thankfully I'm passing almost 6.5 years since my decompression surgery with no new leg pain, and passing 6 years since I've been training in olympic weightlifting.  2020 was obviously a challenging year for everyone, and I did have some hip and lower back soft tissue injuries while training early last year, but I worked through those and they were pretty much unrelated to my spondy.  

I managed to compete twice in late 2020 in online competitions, and hit a PR in my clean and jerk (108kg / 238 lbs) and came within 2kg of my 2019 competition PR in the snatch at 86kg (189 lbs).  Planning to compete online this year until the vaccine is more widely distributed and in person competitions become more prevalent again.

Hope everyone is able to exercise and train through their spondy and the pandemic.  

Stay well and stay safe!

#crossfit #weightlifting #spondylolisthesis

Happy 2019!

Happy 2019 to all.  Sorry for the lack of posts here, but not much new to report, fortunately. 

I continue to lift and hit PR's, and in fact competed in 3 weightlifting meets in 2018!  I'm starting to believe that olympic lifting (snatches, cleanes, pulls) is actually strengthening my lower and mid back musculature to a point that it adds stability to my lower back.  That being said, I try to focus heavily on form, form, form before loading, as well as extra core work.  I still mostly avoid irritating movements (situps) but sometimes do T2B, and when I do burpees, I don't usually combine them with heavy lifts due to the possibility of fatigue leading to breakdown in midline stabilization. 

Very thankful that I can continue training and hope that I can continue to do so for a long time.  Sorry for the delay in updates and replies, but I hope that those of you out there dealing with spondy are thriving and improving as well!  Keep searching for answers and keep searching for experts - there are good PT's, coaches and docs out there who can help with this condition.

Cheers.

Fantastic article on the new science of treating lower back pain

Wanted to post this amazing article about back pain and treatment and the new thinking on it.

https://www.vox.com/science-and-health/2017/8/4/15929484/chronic-back-pain-treatment-mainstream-vs-alternative

Clearly, the traiditional standbys of rest, surgery, injections and drugs aren't working for many back pain sufferers, but exercise, core strength and PT are.

It's a great read and great validation of the importance of staying active, staying strong and not just blindly following passive treatments.  Certainly there are situations where surgery and injections can help and are needed (and in my case a decompression surgery was absolutely needed) but they shouldn't be the only treatment for anyone with lower back issues.

And, of course, what back pain article would be complete without a mention of Dr. Stu McGill, the spinal biomechanics expert, and his "Big 3" exercises?  He is truly a well of knowledge for those of us with back issues and his research and exercises are back savers.

Anyway, enjoy the read and good luck with your spondy journey!

2017 Updates

Here's a quick update for any followers still out there or folks still dealing with a spondy.
I'm still humming along, doing olympic lifting 3 days a week, including heavy snatches, cleans, jerks and pulls, doing CrossFit 1-2x a week and playing sports.  No new leg pain or low back issues.  I do get some occasional mid and upper back tweaks from olympic lifting but those all seem to be soft tissue and don't last fortunately. 

I competed in two weightlifting meets in 2017 and plan to compete in at least 2 next year as well.  Just recently I PR'ed both my snatch and clean and jerk, and PR'ed my squats this past year as well!  I don't attempt heavy deadlifts, but to be honest, I feel like heavy pulls and lifts have actually made my back feel better and stronger.  I now have spinal erectors that I can actually see and feel, and though I thought it was pretty good then, my core strength is way beyond what it was a few years ago.  I feel very blessed and hope that I can maintain this. 

Anyway, hope everyone is getting the help and treatment they need and taking care of themselves and seeing good progress.  Hit me up with any comments or questions.

Happy Holidays and Happy New Year Spondy athletes!!

#crossfit #weightlifting #spondylolisthesis

Interesting article on Spondy surgery outcomes

Hey folks, just saw this study posted in the NE Journal of Medicine, and thought it might be of interest to those considering surgical options for spondylolisthesis:

In a nutshell, adding fusion on top of lumbar decompression/laminectomy may have no added benefit for those with just radiculopathy (leg nerve) symptoms.

Something to consider if you're being told you need a fusion.

As for me, I continue to do CrossFit and (olympic) lift 3 days a week.  In fact, I did my first olympic weightlifting meet, hitting a PR in my clean and jerk (99 kg / 218 lbs)!
I also continue to hit the core work hard:

- front squats
- weighted planks
- dead bugs
- bird dogs
- reverse hypers and GHD hip extensions (being careful to AVOID hyperextension)

Hope everyone is healing or figuring out ways to continue to train while avoiding pain.

Cheers.

#crossfit #weightlifting #spondylolisthesis

Late fall Update

Howdy spondy athletes.  I see that my blog posts have attracted some attention in Google searches, so I guess there must be a good number of you going through this situation, unfortunately.  I am sorry if that is the case, and I hope that my blog provides some useful knowledge for those in a similar situation trying to decide what to do, especially you athletes out there who want to stay fit and active despite a spondy.  I try to use the knowledge I've gained along the way to guide others and help them avoid a spondy if they don't have one, but if they do, how to manage it and when to consider next steps.

As an update for me, I continue to work out and live pain free.  I am still following my previously described guidance, deadlifting rarely, watching my loads during CrossFit, and only going heavy in low rep situations.  That being said, I have hit a couple of new PR's on the olympic lifts, so I am pretty stoked about that, and it hasn't seemed to introduce any new symptoms.  Again, I am very careful to maintain good form and lock in my midline before and during every lift.  I use a lifting belt for most lifts (this one, since it has a section that goes over L5-S1).  I also played my sport all summer without any issues and continue to walk, run and dance pain-free.  Hoping it will last!

Anyway, as always, feel free to post questions or comments to the blog!

Be well!

#crossfit #weightlifting #spondylolisthesis