### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I was found to have spondylolisthesis at around 12. Fast forward to 2012, and it was found at L4-L5 level, there is a minor disc bulge with minimal flattening of the ventral aspect of the thecal sac with no compromise of the exiting nerve roots. At the L5-S1 level, there is a minor anterolisthesis of L5 relative to S1. The disc bulge extends to the foramen on the left, without any significant impingement of the exiting root. There is an unusual appearance the facet joints bilaterally at the L5-S1 level. No pars defect on either side at L5. There is a small well-corticated bone fragment seen, related to the facet joints bilaterally at this level, larger on the left than the right. Possibly developmental. There was also some superimposed degenerative change at the facet joints. Anterior Spondylilolisthesis of L5-S1(as reported on MRI, CT scan, and from Surgeon Dr. Ganesh Swamy in Calgary, Alberta). Fast forward to now, I moved back to Ontario, I ve had 5 children(yes, you read that right FIVE children), and my pain is significantly worse. I go to my nurse practitioner I m on lyrica(6-9 75mg caps.per day), 8 extra strength Advil, 12 Tylenol 1 s daily to try and manage pain. I got sent to North Bay, Ontario for an MRI, to be told that the only thing wrong with my back now is an ever so slightly slipped disc at L5. None of the other problems exist.I also had an X Ray in 2013 that stated the same. Can someone explain to me how my back got miraculously better, my pain got significantly worse, and maybe an explanation as to what s wrong. I just don t want to be in pain anymore. I want to be able to play with my kids again. I also have had 2 ultrasounds on my liver saying it s large n comparison to my body, and yet when it was felt by my specialist, he sad it felt just fine it doesn t seem large at all. Please, i m begging you, help me. I have nowhere else to turn and Im in pain nearly every day

### output:

Dear patient spondylolisthesis at 2 levels L4l5 and l5s1 back in 2012 and constant increase in pain since then may be due to increase in Lachesis and degeneration in facet joints. You are taking high dose of analgesics which itself suggests significant liability. first I would like to advise digital of X-ray of lumbosacral spine anteroposterior and lateral views.  Lateral views should be taken in full flexion and full extension position also known as dynamic views. This gives idea about instability due to Lachesis. I would also advise recent MRI of lumbosacral spine with screening of whole spine to know about condition of disc and facet joints. Please do it now. Please consult expert spine surgeon around you. If X-ray is showing dynamic instability surgery may be indicated. Thanks.