Running Out of Non-Surgical Options

by Dan
(Florida)

I am a low back (L5-S1) patient that has had everything done over the past four years without any success (only local 3-4 level pain when walking that also includes a good deal of instability while walking - with a pronounced backward lean).

I am now very close to deciding on Anterior or Posterior Fusion Surgery to provide more stability to L5-S1 where I have a 2-4MM retrolisthesis (can be seen on any of my MRIs).

Before I go under the knife with a doctor I would like your opinion on what is really causing the backward lean from a kinesiological perspective. Can this be caused through a naturally fused L5/S1 vertebrate or perhaps iliopsoas weakness?

I can only walk a short distance before my back is pulled in a posterior direction indicating to me that the back muscles won out over the psoas muscles.

Here is my back history(not that interesting):

-Mid - August 2007 - Landed awkwardly when jumping from a rock formation and had acute pain for 2 days
-Late - August 2007 - Saw Chiro- pain subsided to a 2-3 level from 8-10- Local to L5-S1 and it doesn't travel down the legs
-September 2007 - Had 10 sessions of rehab - no real results
- still 2-3 level pain
-September 2007 - MRI - Results indicate L5/S1 compression and dry disks (not uncommon for a 43 year old man)
-October 2007 - Had a steroidal med pack - still 2-3 level
-January -March 2008 - 28 DRX treatments at a chiropractor - No real improvement - still 2-3 level
-July- January 2008 - Saw Chiropractor - Active manipulation - No real improvement - 2-3 level
-December 2008 - Had second MRI - no differences noted from the previous MRI
-February 2009- Saw Ortho again and he recommended pain management
-March 2009 - Visited a pain management specialist and he suggested facet vs. epidural injections
-March - June 2009 - Saw Chiro - cold laser therapy, active manipulation - No Real improvement - 2-3 level when walking
-January 2010 - Facet Joint Injections to L5-S1 (4 joints) with no reduction in pain and, in fact, an increase in anterior pelvic tilt and pain/instability when walking - pronounced backward lean when walking!!!!
-December 2010 - Facet Joint Injections to L5-S1 (4 joints) with no reduction in pain and, in fact, an increase in anterior pelvic tilt and pain/instability when walking - more pronounced backward lean while walking!!!!
-Current - Given up believing that chiropractic techniques will resolve pain for me and have seen one Spine Surgeons about my case - he indicated there may be a natural fusion in 3-4 years, however, I can't really live with my current walking condition(unstable with pronounced backward lean)!

My latest MRI report outlines the slight retrolisthesis and slight L5 herniation abutting the thecal sac at L5-S1. Basically, my L5-S1 disk no longer exists and osteophytes have started to grow. With my instability while walking creating a severe backward lean (I can walk backward fine) I am running out of nonsurgical options.