Isthmic spondylolisthesis
Chief complaint
Right leg pain with walking
History of present Illness
Patient is a 43 year old physician that has
had years of on again off again leg pain. The
current episode of pain started over one year
ago. He is otherwise healthy and previously very
active. He has no pain with sitting, but if he
tries to walk more than a 100 feet pain will
radiate from his back down his right leg and
into the big toe. If he sits down the pain will
resolve. Although he can no longer jog, he can
ride a stationary bike without any problems.
He has tried nonsteroidal drugs which help the
pain, but his function is still very limited.
Physical exam
Healthy appearing 43 year old male in no
apparent pain. He has pain with extension of
his spine but forward flexion is not a problem.
He does not have any hamstring tightness, and
the straight leg test is negative (i.e. no nerve
tethering). He has some weakness in extending
his big toe on the right but no other focal motor
deficits. There is no restriction in the motion
of his hips.
Imaging studies
The X-ray (figure
1) shows an isthmic spondylolisthesis at
L5-S1.The sagittal MRI scan (figure
2) confirms and isthmic spondylolisthesis
at L5-S1, and there is also a disc bulge and
disc dehydration at L4-L5 indicating early degenerative
disc disease. The sagittal scan taken out in
the right foramen (figure
3) confirms foraminal stenosis at L5 impinging
on the L5 nerve root. |
