Question
In 1990 I was told I had spondyolisthesis of L4 on L5.  I recently injured my back falling off a motorcycle and landing on my back/tailbone.  I have numbness in my toes and a bit in my groin area.  I went to a clinic and had X-rays that show quite a bit more slippage of L4, but noone is scheduled to formally read them for a couple days. I'm concerned about permanent nerve damage while I wait out the process.   -- Could permanent damage occur if I don't get treatment soon enough?

Thank you so much for your help.

Answer
Hi Frank,

The combination of:

1. Preset Spinal instability (Spondylolisthesis)
2. A spine injury  
3. X-rays that seem to document progression  
4. Clinical signs that are suggestive of nerve root compression (numbness)

are quite sufficient to warrant further investigation. After proper examination by a Physician, you should have  a CT scan done for better evaluation of the boney elements of the Spine, and an MRI study to evaluate the neurological structures and soft tissue.

Spondylolisthesis ?the forward slippage of one vertebra on top of the other ?may be of several types. Progression of the slippage, is relatively rare and not related to trauma in most instances, and in any case would require an experienced neuro-radiologist or Spine surgeon to diagnose and measure the amount of progression on X-rays taken while you are standing up.
If progression has indeed occurred, combined with clinical and radiological evidence of nerve root compression, Surgery might be warranted. I suggest you seek professional advice on a short (but not emergent) time-scale, just to be on the safe side.

Sincerely,

Dr. N. Rahamimov