Q+A: Spondylolisthesis, Spinal Fusion, and More (Part 1)

Ever since my diagnosis of spondylolisthesis (and especially since my surgery), I’ve had to field lots & lots of questions. It’s not every day you meet someone with a broken back (literally) and a spine that’s been screwed back together, right? I can’t blame people for being curious.

I figured the easiest way to answer all the questions is by, well…answering the questions. This Q&A really serves two purposes – first, to provide info about what’s been going on with my back. And second (and more importantly) to answer questions about spondylolisthesis and spinal fusion for people who’ve been newly diagnosed, are researching treatment options, and/or have a loved one going through a similar situation.

So here goes.

Spondy-what? If you don’t know what spondylolisthesis is, don’t worry – you’re not alone. The first time I ever heard the word was when I was being diagnosed with it. Simply put, spondylolisthesis is a condition in which a bone in your back (a vertebra) has slipped forward.

Here’s a screenshot from my MRI from December 2015.

Quick lesson in spine anatomy: The spinal column is made up of 33 individual bones (vertebrae) and 5 regions. Each bone is identified with a number and letter, which corresponds with its location on the spine. In the photo above, I’ve labeled L4 and L5 – these are the 4th and 5th bones in my lumbar spine. S1 is the 1st bone in my sacrum or sacral region. My L5 and S1 aren’t lined up – can you see that? This is where my spondylolisthesis occurred.

It’s a little harder to see, but my L4 and L5 aren’t aligned properly either. L4 has slipped backwards – this is called retrolisthesis. It’s essentially the same thing as spondylolisthesis, only in the opposite direction.

Here’s a picture of the spinal column for reference:

image source

I had a herniated disc. Is that the same thing? Nope. If you look at my MRI again, you can see an oval-shaped blob in between each pair of bones – these are the discs. A disc is commonly compared to a jelly donut, with a gel-like center and a firmer outer layer. Think of it as a cushion for the vertebrae. Its job is to protect the spine and provide shock absorption.

If you start at the top of my MRI, you can see that all of the discs are intact and similar in shape – until you get down to L4. That’s where everything starts getting funky. See how the discs at L4-L5 and L5-S1 look kind of smushed? That’s another reason for my back pain. I have a bulging disc at L4-L5 and a herniated disc at L5-S1. A bulging disc is one that is compressed so that it extends beyond its normal space – imagine pressing down on a jelly donut so that it becomes flatter and wider. With a herniated disc, the gel from the center of the disc is actually protruding through a crack in the outer layer. Take that same jelly donut and press on it until some of the jelly seeps out. That’s what’s happening in my back, only without the sweet gooey goodness.

You don’t literally have a broken back, do you? Actually, yes, I probably do. Spondylolisthesis most commonly occurs due to a fracture or defect in the pars interarticularis – a small segment of bone that connects the facet joints in the back of the spine. source

A photo posted by Sharon 💕 run | yoga | joy (@mommyrunsit) on Oct 26, 2015 at 7:41am PDT

So how did you get spondylolisthesis? Was it caused by running? This is probably the question I’m asked most frequently. The simple answer is: no, probably not. Spondylolisthesis can be caused by: (source)

• a birth defect
• fractures
• spondylolysis (a defect or fracture in the pars interarticularis)
• degeneration due to age or overuse
• tumors
• surgery

The most common type of spondylolisthesis is isthmic, or a fracture in a part of the vertebra called the pars interarticularis. The fracture can be caused by trauma, but more commonly it occurs from hyperextension (arching) & overuse. Spondylolisthesis often occurs in child & adolescent athletes – gymnasts, wrestlers, and weightlifters are particularly susceptible – but not runners.

My surgeon believes that my spondy is dysplastic or congenital, meaning that I was born with it. This means that I have a defect in my vertebra that allows it to slip forward. It’s common not to experience problems from a dysplastic spondy until adulthood.

How were you diagnosed with it? Back in spring 2015, I started having pain in my hips, legs, and right foot. I attributed this to wearing worn-out running shoes. And once I was properly fitted in a pair of new running shoes, my pain did subside.

A photo posted by Sharon 💕 run | yoga | joy (@mommyrunsit) on May 9, 2015 at 11:29am PDT

That summer, I traveled and hiked and walked a ton, all relatively pain-free. But in the fall, I started having pain in my right hip and, later, my right foot started getting numb. At first I blamed my IT band; then my piriformis. I stretched and foam rolled and walked instead of running, but it only got worse. Finally, it got to the point where standing still for more than a few minutes caused excruciating hip pain. That’s when I finally decided to see a doctor.

I assumed that I had some sort of overuse injury caused by running, so I was both surprised and skeptical when my doctor hypothesized that I had a bulging disc. Sure, I was having lower back pain, but I’d had it for nearly 20 years and barely gave it a second thought most of the time. I didn’t think that a problem with my back could be the cause of my hip pain.

A photo posted by Sharon 💕 run | yoga | joy (@mommyrunsit) on Dec 8, 2015 at 12:01pm PST

My doctor referred me for an MRI and physical therapy – and the physical therapist ended up being the first one to suggest that I might have spondylolisthesis. Turns out that the bump that I’d had on my lower back pretty much forever wasn’t supposed to be there! It was actually my slipped vertebrae pushing against my skin. The MRI confirmed the physical therapist’s diagnosis.

In part 2 of my Q&A, I’ll talk about treatment options for spondylolisthesis and how/why I decided to have a spinal fusion. Please be patient with me – my recovery is going really well, but I’m exhausted pretty much all the time – plus it’s still pretty uncomfortable to sit up and type on my laptop. If you’re interested in more regular updates on my progress, let’s connect on Instagram. Also, if you have any questions, please don’t hesitate to leave a comment or send me an email at sharon{at}mommyrunsit{dot}com.

Talk soon. xoxo