Assessed for Meyerding grade level? How would you do that without imaging?Originally Posted by Will Morris
Starting Strength Coach
You don't think that a spondy can't be assessed through a physical exam?
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Assessed for Meyerding grade level? How would you do that without imaging?
Starting Strength Coach
Spondy's cause deformities. The deformity can be assessed on physical exam. If the deformity worsens, or if there is a pronounced step off, maybe a radiograph is warranted, but, you have a known lesion. What is the diagnostic utility in repeat imaging of an asymptomatic lesion, without neurological deficit, that appears clinically stable on physical exam other than prepping an oncologist for business in 20 years?
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Just to be clear, I have a confirmed spondylolisthesis, not just a spondylolysis. I already have a step-off that has been found on physical, and confirmed (and graded) by radiographs and MRI. The Meyerding grade and clinical assessment of stability were determined based on lateral and flexion/extension radiographs (prior to surgery).
My thinking was that repeat imaging would demonstrate at least whether there has been increased progression of the slippage over time and since the surgery. The mental leap I made from there, perhaps mistakenly, is that if I do see evidence of the slip progressing significantly (since most research indicates adult slippage does not progress after skeletal maturity) that might be an indication that lifting is contributing to it and that I should back off before I end up with neurological deficit. I guess my big fear is ending up with some sort of "catastrophic" slippage due to lifting and irreversible cauda equina syndrome. If you tell me it's an irrational fear, then I will be only too happy to hear that. I'm just trying to figure out the best plan of action here. Thanks for your help.
Starting Strength Coach
Just to be clear, I am familiar with the difference between a spondylolisthesis and spondylolysis, and everything I have said up until now has been referencing a spondylolisthesis.
The overall incidence in adults of spondylolisthesis is somewhere between 5 and 12%. The overall incidence of cauda equina syndrome in a spondy is (forgive me for not having the source) something to the tune of .03%. The fear you have is warranted, because it can happen. That said, if you have an unstable spondy, bending over to pick something up at the grocery store is every bit as dangerous. It is up to you to analyze the risk-benefit of how you are going to live your life, and what you are going to refrain from doing based off the .03% chance something could happen.
A lumbar spine panel you described will be something to the tune of 50 chest x-rays. My contention is that a proper physical exam and continuity of care would limit the necessity to further irradiate your abdomen. If you and your physician disagree, and you both determine the best course of action is yearly lumbar panels, then do what brings you piece of mind. For me, as a clinician, if I have no medical red flags, no high energy trauma, no progressive neurological deficit, and pain that is mechanical in nature, I want no imaging at all because the chance that a lesion on imaging is directly causing the pain is scant, at best. Not all patients are like me, but that's how I roll.
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OK thx - it's just that in the case of the docs that I've seen, none has made a definitive assessment of my spondy based on a physical alone (the sports med doc didn't detect it until the x-rays), and the neurosurgeon wouldn't even see me until I had a (repeat) MRI. My pain was strictly radiculopathy down the leg, with zero back pain, and since the symptoms corresponded exactly with my MRI, the neuro felt that the spondy was the direct cause of the nerve compression and stenosis (and he was right, obviously).
Thanks for this info. This is very helpful. Part of the challenge is that none of my docs are knowledgeable about exercise and lifting and none are fans of heavy lifting, so I doubt they'll be too happy if I go to them for follow-up and tell them I want to track it because I'm lifting. They'll likely just go for the minimum risk approach, tell me not to lift anymore and to come back only if I experience new pain. It's really hard to find clinicians who have both the knowledge of the medicine AND an understanding of biomechanics of exercise. At least I haven't found any locally yet. And in my risk-benefit analysis, I feel like I want to lift and continue to get stronger. I feel so much better when I do.
One last question - would you count oly lifting as high energy trauma as Rip would? ;-)
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