Question
I recently had an MRI done due to back pain in the lumbar area  and an Xray indicated Spondylolisthesis. I received a copy of the MRI report to find out what the report says prior to the follow up Ortho appointment which is still weeks away. The report impression: L4-5 broad based disc herniation with right central annular tearing. Grade 1 anterolisthesis of L5 on S1 with associated disc uncovering and posterior disc herniation and right subarticular annular fissuring which results in severe bilateral neuroforaminal narrowing. Mild disc disease of L4-L5 and minimal superior lumbar facet arthropathy. A small hemangioma with in the T12 vertebral body. My main questions are, Do I need to be concerned with the hemangioma? I'm guessing that since the Doctor has not called me about it that I should not stress. Finally, for the past few weeks, have had the feeling that I needed to urinate and when I try to go its very little or nothing at all most of the time. Could this be early signs of the dysfunctional bladder that I have read about? It does not burn or hurt to pee. I just constantly feel the need to go. I try about every 10 minutes or I feel like I am going to wet myself. It has effected (pretty much stopped) intimacy with my wife. I'm 35 and otherwise healthy.

Thank you in advance for your time.
Jason

Answer
Spondylolisthesis describes the anterior displacement of a vertebra or the vertebral column in relation to the vertebrae below. Grade I is 0-25% anterior slippage, the least severe. This is not an uncommon condition with a reported prevalence of 5%-7% in the U.S. population. The spondylolytic defect is usually acquired between the ages of 6 and 16 years, and the slip often occurs shortly thereafter. Once the slip has occurred it rarely continues to progress. Although not necessarily symptomatic it can be argued that the biomechanical stresses incurred by the joint are greater than they might be otherwise and that there is a greater likelihood of disc degeneration and associated osteoarthritic changes at this level. You are a case in point and absent an injury of some sort is as good an explanation as any other as to why this has happened to you.

You are correct to not stress about the hemangioma. A hemangioma is a benign tumor and is considered to be an incidental finding and rarely of any consequence. An incidental finding means it's there, everyone can see it, but it doesn't matter. That is not to say that they never cause problems, but that problems are rare.

The dysfunctional bladder is cause for alarm! This must not be allowed to continue or worsen and indicates that you are running out of time to handle this disc issue by any conservative means. In other words, if you wake up one morning with the inability to urinate you'll have to have spinal surgery within 24 hours, like it or not, with no further discussion as this now becomes an emergency. Report what you have told me here to the Ortho and I feel certain that the "follow up Ortho appointment which is still weeks away" timetable will be moved up considerably.

Your description of the dysfunctional bladder indicates to me that time is short, but it may not be too late to consider spinal decompression therapy. Decompression Therapy is a non-invasive, non-surgical treatment performed on a special, computer controlled table similar in some ways to an ordinary traction table. A single disc level is isolated and by utilizing specific traction and relaxation cycles throughout the treatment, along with proper positioning, negative pressure can actually be created within the disc. It works by gently separating the offending disc 5 to 7 millimeters creating negative pressure (or a vacuum) inside the disc promoting the retraction of the bulging disc tissue. This negative pressure also pulls water, oxygen, and nutrients into the disc, thereby re-hydrating a degenerated disc and bringing in the nutrients needed to begin the healing of the tear in the annular fibers which are the tough ligamentous type fibers around the disc.

Schedule a consultation as soon as possible with a facility that offers this treatment and see what the doctor says while you still have a choice in the matter. Go to the link below to find out more.

AUTHOR BIOGRAPHY
Dr. Michael L. Hall, D.C. practices at Triangle Disc Care in Raleigh, North Carolina specializing in Spinal Decompression for the treatment of acute and chronic neck pain and back pain due to herniated, degenerated discs. This is a conservative procedure for patients suffering with bulging or herniated discs, degenerative disc disease, posterior facet syndrome, sciatica, failed back surgery syndrome, and non-specified mechanical low back or neck pain.

For more information call go to http://triangledisc.com/decompression.php.