Disc Bulges, Ligaments and Retrolisthesis: Gold Standard Care

Patient Case Overview

This is Robert Shanks' reply to a real patient who wrote in after receiving his MRI report, reproduced here as a case study for anyone facing a similar diagnosis.

A patient sought guidance following an MRI scan revealing a small disc protrusion at L5/S1 (the lowest disc in the spine) with retrolisthesis, a backward shift in vertebral position.

The MRI indicated a small focal disc protrusion not contacting nerve roots, retrolisthesis at the same segment, and likely ligamentous slack or damage associated with disc degeneration.

Treatment for Disc Decompression: IDD Therapy

IDD (Intervertebral Differential Dynamics) therapy was recommended, with its oscillatory function capable of targeting specific disc spaces. This is a category 1 to 2 lesion. Patients typically need 24 to 30 sessions for maximum improvement, though some relief may appear within 6 to 12 sessions.

Treatment for Segmental Stability

Retrolisthesis suggests ligamentous laxity, requiring a multi-faceted approach to stabilisation:

• Core strengthening exercises targeting the transversus abdominis and multifidus muscles, the off-the-shelf Core Zero to Core Hero programme is a good starting point
• Focused shockwave therapy to improve ligamentous integrity, we're one of the few UK clinics equipped with a Swiss DolorClast focused shockwave machine, independently proven to produce true shockwaves
• Prolotherapy (3 to 4 sessions with a specialist) for enhanced ligament repair through fibroblast growth factor upregulation, we recommend Dr Simon Petrides at the Blackberry Clinic in Milton Keynes for this

Diagnostic Enhancement

To determine whether the retrolisthesis is dynamic, meaning it moves under load, upright or dynamic MRI imaging with flexion and extension views was recommended. This provides superior visualisation compared to standard supine MRI, and costs approximately £800. It's particularly useful for identifying movement-related instability that a standard scan may miss.

Upright and dynamic MRI scans of this kind are offered by providers including the London Upright MRI Centre, the Birmingham Upright MRI Centre, and Medsereena's clinics in west London and Manchester.

Exercises to Avoid

The patient should avoid heavy axial spinal loading exercises that could exacerbate backward vertebral slippage. These include:

• Heavy overhead presses
• Barbell back squats with heavy loads
• Heavy deadlifts with poor form
• McKenzie extension exercises

McKenzie extensions in particular may worsen retrolisthesis by increasing posterior shear on already-compromised segments.

A home decompression/traction exercise can help, but won't achieve the same level of disc decompression or hydration improvement as IDD therapy under clinical supervision.

Summary

The gold standard approach for disc protrusion with retrolisthesis combines IDD therapy for disc decompression, targeted core rehabilitation, and ligament strengthening through shockwave and prolotherapy. The aim is to restore segmental stability, reduce nerve irritation, and avoid further posterior slippage.

To discuss your MRI findings and treatment options, call us on 020 8506 1000.

Written by Robert Shanks, Director of Spine Plus and lecturer in the interpretation of spinal MRI for manual therapists.