Overactive back extensors w/ spondylolisthesis at L5/S1

[SPPAWA]

Hello Spondy,

What are your reflexes like when they test them. Are they very jumpy and accentuated. When they tap your knees with their hammer do they fling out briskly from 90 degrees (if seated) to straight and make your whole body kinda hop as if you were really surprised by being struck by the reflex hammer? Do you have any charts with the numbers they have awarded these reflexes?

Thanks,

SPPAWA

[spondy_21]

Hi SPPAWA,
I don't have any charts with a number ranking for my reflexes.
I have been tested several times in the past couple of years, and no doctor ever noted anything abnormal/extraordinary. That includes a thorough physical exam w/ reflex testing by a neurologist.

[SPPAWA]

Hi SPPAWA,
I don't have any charts with a number ranking for my reflexes.
I have been tested several times in the past couple of years, and no doctor ever noted anything abnormal/extraordinary. That includes a thorough physical exam w/ reflex testing by a neurologist.

Hello Spondy,

Without physically examining you myself I cannot say much. There is a possibility, and it is often missed in such cases, where your lumbar spinal extensors are being activated due to the cord compression in your neck (depending on the degree of compression). With cervical myelopathy (cord compression in the neck) the fibers that are most susceptible to compression from extruded discs or degenerative changes are those which are traveling down to the lower limbs. Another pathway called our reticuospinal projections also travels through this section and can be affected depending on the degree of cord compression which you have.

With cord compression in the absence of any compromise to peripheral nerves one will usually exhibit accentuated reflexes which would occur in reflexes which exist below the level of cord compression. You can think of the role of the above mentioned pathways as "dampeners of reflexes" and thus, when compromised, will lead to the accentuation often seen on examination. This being said, your posture is controlled by reflexes. Spinal posture is controlled in particular by reflexes associated with the vestibulospinal projections which travel through the neck as well to control postural reflexes within the lower back. If the dampening mechanism is compromised due to cord compression it will result in increased tone in posterior (back side) extensor muscles in the lower limb and spine. Increased activation of these muslces, which is commonly seen in individuals who have suffered stroke leads to the odd gait (wallking) pattern where patients hike their hip up and over (circumducitve gait). This occurs as they cannot activate opposing muscles to overpower the extensor tone in the their hip due to and upper motor neuron lesion whether that be located in the brain or spinal cord. It is possible that your neck injury has caused some compromise of the dampening mechanism to these reflexes. Have you also noted stiffness in the legs?

In the event this is the case and other more common treatment avenues have not helped, I would search out a practitioner with experience in vestibular rehabilitation. Increasing the efficiency of the vestibulospinal projections through exercises aimed at them, as has been my experience, leads to improvement in patients I have managed with chronic extensor tone below the level of T6.

I hope this helps.

SPPAWA

[spondy_21]

Thanks, SPPAWA. That's a lot of information. I had to sit with it for a bit, but I understand what you are saying now.

I went through a battery of physical tests with a neurologist who said I was fine - not very helpful. I know the spinal cord is not being compressed now/for the last year because of surgery. Lord knows I have had bizarre feelings and fits all around the muscles of the shoulder blade, rib cage and extensors during the, hopefully, healing process.

Who, that is, what kind of doctor would I go to to verify myelopathy?

[SPPAWA]

Hello Spondy,

I would assume your neurologist would have followed you up with an MRI after your surgery. There is the possibility of some remnant cord damage from previous compression, however, this would be considered only after examination were suggestive of it.

I feel your overactive back musculature is likely firing in an attempt to stabilize your lower back which with a spondy will be inherently unstable. A spondy is a chronic degenerative condition, although often asymptomatic, it will continue to slip as you age. Low impact exercise to keep excess weight off will help keep the stress to the area minimal... NO RUNNING. I would continue with your rehabilitation focused on core activation and ask whomever you found the best therapist who has helped you to date who trained them and see that person. It is possible that you have some micro movement recruitment / firing pattern issues which are promoting your discomfort in gait. I assume they have taken another X-ray of the lumbar spine and assessed your spondy recently for an updated grading?


Cheers,

SPPAWA

[spondy_21]

Hi SPPAWA,
Again, thanks for your time. The neurosurgeon thinks my issues are muscle and not nerve related. The neurologist thinks I "am focusing on the things that are wrong with me and not the things that are right." I kid you not - it was fun to pay that co-pay.

With all due respect, I have read and heard so many contradictory things about the spondy. I also had a PT who has a spondy at L5 and is an avid runner. He advised extension, while every other professional specifically advised against it! Once my back started to hurt less at the facets, I began some extension stretches. They have been great in loosening up my abdominal muscles.

Anyway, I'm not even thinking about running now. I just want to take my dog for a walk and actually enjoy it. I will continue with the core work for sure and am still looking for a good PT that I can work well with.

Thanks again,
SPPAWA