MRI ??? Please

[angiebee]

Hello,
For the last year I have had issues that are a lot like neurogenic claudication. I've been to the neurologist who felt my problems were small fiber neuropathy, however in the last month I've had a lot of back pain, mostly when walking but not always. This is in addition to the pain in legs when standing/walking.  I requested an MRI. I have copied the results (just the impression) and would like to know if this could cause neurogenic claudication? And what might the treatment be?? Thank you for your help.
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IMPRESSION: Spondylolisthesis due to spondylolysis at L5 -S1 in combination with disk disease, resulting in severe foraminal narrowing bilaterally.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Based on the reading of the MRI that you provided, I would expect that the intermittent neurogenic claudication is from the L5/S1 stenosis. Some people may note spontaneous improvement in symptoms with time. The initial treatment options are usually NSAIDs, physical therapy, and muscle relaxants. Adjustments to your posture (i.e., walking slightly stooped forward or using a cane) may relieve symptoms as well. If you fail these options, you may benefit from a consult to chronic pain for possible spinal nerve blocks. However, for those whose pain is intractable or people with neurological findings (e.g., muscle weakness, loss of bowel or bladder, loss of sensation esp in pelvis, or severe/progressive pain), a laminectomy (surgery on the bones of the back) is indicated.

If you have not already had one performed, you should obtain an EMG/NCS of the legs to assess the nerve damage. This test can be performed in most outpatient neurology offices. Additionally, I am not sure about the small fiber neuropathy workup, but you should continue seeing your neurologist to discuss further neuropathy workup in light of these MRI findings.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[angiebee]

It was brought to my attention that the whole MRI report may be helpful. So here it is.
MRI Findings: Grade 1 anteriolisthesis of L5 upon S1 is present, measuring 8mm. Bilateral pars interarticularis defects are present. There is mild disc dessication at L5-S1 with minimal endplate signal changes. Remaining intervertebral discs and vertebral bodies are normal in size and signal intensities. Spinal cord terminates normally, exhibiting normal size and signal. The tip ends roughly at L1-L2. No significant disc bulging or evidence of stenosis is seen from L1-L2 through L4-L5. L5-S1 demonstrates listhesis due to bilateral spondylosis. There are hypertrophic changes around the defects as well as some mild facet arthropathy. There is uncovering of the disc margin with mild superior migration/extrusion of the disc associated with annular fissure. Canal is not stenotic. There is, however, severe narrowing of the neural foramina primarily in the craniocaudal dimension due to a combination of these factors. RESULT/IMPRESSION: spondylolisthesis due to spondylolysis at L5-S1 in combination with disc disease, resulting in severe foraminal narrowing bilaterally