I am 7 weeks pregnant and have grade 1 anterolisthesis L5 on S1 secondary to bilateral L5 spondylolysis. Also with mild to moderate degenerative disc changes L5-S1. Will delivering baby vaginally cause more damage?

Hi there:
I have Grade 2 anterolisthesis of L5 on S1 and had absolutely no problems during the whole pregnancy and vaginal delivery without any drugs. Hope this helps. Good luck!

I am no expert, but I have spondylolisthesis. Grade one anterolisthesis associated with bilateral L5 spondylolisis and mild scoliosis. I have an 18 month old and gave birth naturally. It was very painful, all of my pain was in my back and nowhere else. Having said that, I got through it all without an epidural and once my baby was born the pain stopped. I have experienced more back pain since having my daughter than I did before I had her, however this is because my core muscles & abdominals are not as strong as they used to be. It is not related to the birth. I have had follow up x-rays and there is no further slippage.

Hello Again, D-

I did a literature search to find an answer to your question. You are right, it isn’t easy information to find, and I’m not sure why that is. I did find a few articles. None of them specifically answer your question, but they do cover the topic in a general way.

My take is that assuming your back is stable, the pregnancy itself may be just as much a strain as a vaginal delivery. Of course, everything will depend on your history and your specific situation, but generally I get the impression that the very best thing you will be able to do is to work with a physical therapist on core strengthening to hold your spine in place as much as is possible. Pilates, swimming, and yoga are low and no impact, and they strengthen your core. A strong core means a more stable spine.

I’ll list the addresses for these articles for you so you can read them and talk to your doctor. As long as your medical team is aware of your issues and you stay in the best condition you can, if your spine is stable hopefully a natural delivery won’t be any worse for you than the pregnancy.

I’m very glad you wrote, because I learned some things myself today. Good luck and please keep us posted.

Sources:

Ask the Experts: Can Spondylolysthesis cause Complications During Pregnancy?
http://www.physioroom.com/experts/asktheexperts/answers/qa_tj_20040413.php

Trevor Lee, FRCS & Harold Ellis, MCH, FRCS: Rectosigmoid Obstruction Due To Compression between calcified ovarian tumors and the lip of an advanced spondylolisthesis. Journal of the Royal Society of Medicine. Volume 77, June, 1984. (Look at page 3.)
http://bit.ly/bVzQDY

O. Bryekhov & G. Sulima : Pregravid management of women suffering from spine degenerative disease. The Internet Journal of Minimally Invasive Spinal Technology. 2009 Volume 3 Number 4.
http://bit.ly/cn4L0W

Paul L. Sanderson & Robert D. Fraser: The Influence of Pregnancy on the Development of Spondylolisthesis.
http://bit.ly/bG0Gld

Saraste H: Spondylolysis and pregnancy--a risk analysis.
Acta Obstet Gynecol Scand. 1986;65(7):727-9.
http://www.ncbi.nlm.nih.gov/pubmed/2949484

Hi Djwill575-

First, congrats on the pregnancy! You have a tough few months ahead, but it will be well worth it.

I have a few questions for you. Were any of the surgeries on your back? Spondylolysis with anterolisthesis usually means you have an unstable area in your back. If it doesn't heal with conservative therapy they often do a fusion for this. Have you had a fusion done? If you have not, I worry that you have an unstable area in your spine.

Have you had physical therapy? If you have, remember the exercises and tips they gave you about posture and positioning. For instance, you are going to want to walk a lot on flat surfaces. Sitting as you would sit in a normal chair like an office chair is going to put the most pressure on your low spine. So you need to change position often, walk as much as you can, and when you aren't walking try not to sit a lot at the 90 degree straight-backed chair angle. You may be able to do some water exercise or aqua therapy, and that will probably feel great.

There are some pain medications that you can take during pregnancy, preferably sporadically rather than daily. Doctors are very careful and hesitant about this, so you may need to see a pain therapy specialist if your pain gets severe. You could probably have epidural injections at some point if you really needed them. Some women have surgery during pregnancy, so it's all about balance and risk versus benefit for you and the baby. I say this so you know that you don't have to just suffer with terrible pain through the whole thing, there are things that can be done to help you. There is a pain safety net for you.

Pregnancy does stress your back; even women without your diagnosis have back pain while pregnant. But they do have babies. I found a page on Spine Universe this morning: http://www.spineuniverse.com/experts/spondylolisthesis-pregnancy

I want to look through my references for resources and get back to you with more information. Please remember that many doctors who are not obstetricians are a little afraid of pregnant patients. I'm not insulting doctors at all. I've worked with terrific doctors, but once you say "pregnant" they get very hesitant about meds and treatment because it is sometimes a gray area and they don't feel they know enough to prescribe. They nearly always defer to the obstetrician out of this nervousness and fear of harming a baby with their lack of expertise in that area.

Most pain therapy clinics will be familiar with this as they are the last stop for patients with pain. I think if you work with your obstetrician and a pain therapy doc as needed, you will do well as long as your spine is stable. If you can answer that for me, it would be helpful, and I'll get back to you with more specific resources, hopefully today.

Be good to yourself.

DJwill575,

Welcome to EmpowHer, and thanks so much for your question.

Did your orthopedist have an opinion on vaginal vs. C-section delivery?

One of our moderators is a nurse who has a lot of experience in the area of the back. I am going to make sure she sees your question as she may have some insight for you. Hang in there with us, OK?