Is grade 2 18mm spondylitis thesis L5 on S1 bilateral serious condition?

It stuns me sometimes on how patients get nothing much from their treating clinicians. Only just yesterday I got my receptionist to call and arrange an review appointment for a young patient (21 yo) with confirmed grade 1 spondylolisthesis as she is now pain free and thought there is no need for further appointments. She ended up dropping few tears after she realizes the severity of the problem (in relation to her age), but I am sure she will be fine, as I've educated her on what the problem is, why, and what to do / not to do in future, and giving her treatments that will help control the problem.

1. roto-scoliosis: nothing to worry about at all, unless it progresses quickly which I doubt it will. 

2. grade 2 spondylolisthesis: not a good thing honestly, as this damage is irreversable and will gradually get worse. When it's severe enough, there will be pins and needles, numbness, muscle weakness, decreased movement control, poor bowel/bladder control, +/- severe lower back pain. If your physio or chiro didn't explain to you or tell you what to expect, I would suggest you either ask them the question or get a second opinion. Before it becomes way too severe, this problem needs to be managed and contained by physiotherapy; once it becomes too severe, operation, ie spinal fusion, will be the only option. 

3. neurologist can't do much at moment, other than assessing your symptoms and keeps eyes on the rate of its aggravation, + maybe prescribe you tegretol to ease the pain, but not fixing the source of the problem. Neurologist assessment will be useful when it's severe to the point that operation needs to be considered as treatment option.

4. acupuncuture is a pain block, not doing anything to the actual damage, other than providing some degree of pain relief. 

You really need to see a physio who knows how to approach this issue, there are things that can drag on but can still be well treated later on, spondylolisthesis is not one of them. 

Don't panic, it's still treatable, but a complete fix promised by anyone is just unrealistic

Thank you Brian for your honest and thorough explanation, my chiro has been telling me that she is helping me to manage this and that it's a life long change for me, to avoid certain posture, heavy lifting, bending wrong way, twisting, reaching up high making my back flex back apparently that aggravates and the exercises she has given me are focusing on strengthening core with pelvic exercises always laying on my back, none if these gave hurt me at all but the physio I saw got me to do an exercise where I had to lay down on my stomach and lift my legs up, I was in horrible pain for a week especially my lower back, hips and buttocks/hamstring set me back a lot I was very disappointed and cancelled seeing him again, Brian do you have any suggestions on any helpful exercises? My chiro also said she doubts I will slip to a grade 3 unless I became obese or had a trauma, is this true? And when you say it can get worse, how can that happen? I'm so scared of staying in pain and never recovering it seems to take so long and so worried if ever facing a surgery sounds so serious, also Brian should I hold off on becoming pregnant longer will I be in more pain then other women due to spondylolisthesis? Thanks so much appreciate your help.

not a problem, glad to help.

1. core stability is definitely the right direction, but there is no recipe from me, as I tailor exercises to suit each individual, if one supposes to work but turns out not, I will then be creative in thinking an alternative while offering the same intensity (same level of difficulty). It's almost impossible for me to advise you what exercises are suitable to your current stage, as I have no sufficient information of you to make recommandation. Things like your pre-fitness level, actual pain in your hip and legs (as in are they localized or referred), degree of your irritability, your physical make-up, behaviour of your neurological signs (if any). Having professional liability in mind, I therefore can't suggest you any specific method or stage of core stability exercises. But the big direction is you need the core muscles not only performing well but also in time of needs in different posture, ie lying, sitting, standing, bending (still need to teach you, as complete omission of bending for the rest of your life is also unrealistic). At the end of the day, once your core muscles are strong enough, free-style swimming is good way to maintain its strength. Progressing too early often would cause more harm than good.

2. can it become grade 3? not a small chance that this may happen. Reasons being:

- you are young and often more active (active but not knowing what to do or a little careless = injury),

- still want to get pregnant (if you present with almost constant moderate neural signs and not improving with physio, you will need to see neurologist and obstetrician for their opinion on whether you should get pregnant. I did come across one patient 10 yrs ago, young female who was warned by neurologist not to get pregnant as risk of paralysis)

- other factors: degree of your neutral lordosis, your physical make-up, level of fitness, degree of core strength, occupation, lifestyle, ageing (we all age, once aged, muscle function declines, so is core stability) ....etc

I wish I can tell you a direct answer, but I don't follow recipe as some clinicians do, this is the best I can do without seeing you.

3. Re your anxiety of slow to none improvement: find someone you know who is good and you can trust, and follow his treatment for 2 months or so, but if improvement is minimum, then see a neurologist for his opinion on surgery. Coz once conservative management fails, surgery is the only option. Surgery is not a fix to all problem, it fixes the worst problem, but create 2nd worse problem. Say if you have L5/S1 fusion, then your L4/5 will sustain greater stress and greater risk of disc bulge and arthritis.

4. pregnancy: I think the question is already answered, but keep in mind, it's nothing to do with better early or later, it's about the right timing.

Your problem can be approached in logical ways, but just need to make sure every step is right in case of aggravating symptoms or actual situation.

I hope this helps, now I should bill your chiro for doing part of his job.

Thanks Stephanie, your compliment is much appreciated.
I am glad that you are now better in control and have found someone who you can trust in your local area, coz after all, the problem won't just self heal in the state of panic and uncertainty.

Short answer to your question re weight loss and spondylolisthesis, the answer is highly unlikley, it's not the major contributing factor to the development of your spondylolisthesis.

I will hand you over to your treating clinician for any future queries, Q&A is part of rapport building between patient and clinicians, and I should let him? her? gain the trust from you.

All the best to your future recovery, and don't delay as this problem will only get worse, get on top of it. Take care.