What would you recommend with an mri report like this:
technique:. Multiplanar mri of the lumbar spine was performed using spin echo technique. T1, proton density and t2 weighted sagittal images as well as t1 and t2 weighted axial scans through the l1-2, l2- 3 l3- 4, l4- 5 and l5- s1 disc spaces were performed.
Findings:. Coronal imaging demonstrates a normal appearance to the spine. In the sagittal plane however there is obvious malalignment with a first-degree anterior listhesis of l4 on l5. The etiology is bilateral pars interarticularis defects. (the l5 vertebra is sacralized; a small diminutive l5-s1 disc is present and normal.)
at anatomical t1 2-l1, l1-l2, and l2-l3, there is a normal appearance to the disc margin, to the contour and size of the thecal sac, and to the exit foramina. At l2-l3, there is some fluid in the soft tissues immediately posterior to the left facet joint, likely a small synovial cyst. The canal at this level is normal.
At anatomical l3-l4, there is desiccation and narrowing of the disc height. There is circumferential bulging of the posterior disc margin, accompanied by some osseous sparring to the left of the midline. Mild impingement on the base of the left foramen is present.
At the malaligned l4-l5 level the medial aspect of the right foramen is moderately narrowed; because of the rnalalignment the foramen is elongated in the anterior/posterior dimension and narrowed in the superior/inferior dimension. On the left side at this level a severe degree of foraminal impingement and likely compression of the exiting nerve root is observed. In addition, lateral recess narrowing is present. Some stress response in the left pedicle of l4 and in the left lamina of l5 is seen as t2 signal increase.
Impression:. 1. A transitional lumbosacral vertebra, with sacralization of the l5 vertebra and a normal-appearing but small disk at l5-s1 noted.
2. Just above this level, at anatornical l4-l5, bilateral pars interarticularis defects have led to a first degree anterior listhesis of l4 on l5. Moderate right and marked left foraminal narrowings are observed. Lateral recess stenosis is present bilaterally but the canal itself is not compromised and demonstrates typical anterior/posterior elongation.
3. At the anatomical l3-l4 level, the disc shows narrowing and desiccation. Mild left foraminal impingement due to left-sided osseous ridging is seen. The canal is normal in size at the disc space and shows some mild coronal narrowing at the upper endplate of l5.
4. All of the visualized interspaces above anatomical l3-l4 are normal. Each of the vertebrae, including l4 and l5 demonstrate normal contour and signal in the marrow space.
This is what a ct scan said: bilateral spondylolysis and a resultant grade 1-2 anterolisthesis of l5 on s1. Mild proliferative changes in the facet joints at this level together with the spondylolisthesis is resulting in a mild posterolateral central spinal stenosis. Otherwise normal computed tomography of the lumbar spine from l1-s1.
