Question
sir/madamm
Please could you tell me what can be done. over 10 years ago i really hurt my back lifting heavy objects,lots of pain. since then i have suffered with pain, sometimes mild sometimes deeply.
However for a year now i have been unable to work due to constant pain and discomfort in my lower back, and down my right leg,and up around my groin area, i have alot of problems just to sit or sleep,or to just be comfortable.
my doctor has given me diclofenac,tramadol,gabapentin,over this period, i have just had a mri scan, and inclose the results;
There is a grade 1 spondylolisthesis at l5-s1 due to pars defects.
there is significant narrowing of the left exit foramen due to this.the alignment is otherwise maintained. there is significant degenerative disc and end plate change at the lower 2 lumbar levels, but no further compromise. there are moderate facet joint degenerative changes, there are degenerative changes in the lower thoracic levels but the lower cord and conus appear nomal,
Please could you shed a bit of light on this for me, many thanks for your time.

Answer
You have less space in the spine for your nerve to "breathe" if you will. A grade 1 spondylolisthesis means the fifth vertebrae has moved forward on top of the sacrum (this creates less space for the nerve). You also have some arthritic changes and disc degeneration that is, to a certain degree, a fairly normal occurrence with aging. All of these things essentially create less space for the nerve to pass through the spine. Increased pressure or irritation of the nerve root can cause the pain you are describing.

The main thing to be concerned with is whether you have a stable spine or an unstable spine. Since you have pars defects, there is the chance that your spine moves excessively during certain motions. This is an unstable spine and sometimes requires surgery to fix. Flexion and extension x-rays of the lumbar spine can help determine whether your spine moves more than it should.

I would suggest you get evaluated by someone who specializes in physical medicine to see if a regular regimen of exercises to strengthen your back, torso and abdominals would be beneficial. A good stretching program and some manual therapy may also be helpful.