Diagnosis: Sciatica, right side. Spondylolisthesis, multiple sites in spine. Sciatica, right side. Spondylolisthesis, multiple sites in spineClinical question: hx of L4-5 spondylolisthesis, hx of Lung ca. Evaluate for abnormality, stenosis.Signs and Symptoms: Right leg pain and weakness MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is higher marrow signal on T1-weighted imaging at the T6, T7 and T8 vertebral bodies which suppresses on the inversion recovery images indicate that there is greater fatty replacement these levels. This could be a result of radiation effect. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are appreciated in the thoracic spine.There are some interstitial thickening present in the right lung.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is mild anterior subluxation of L4 on L5 which has not changed substantially since 2009.. There is redemonstration of a large perineural Tarlov cysts in the sacral spinal canal at the S2 segment level associated with expansion of the sacral spinal canal and displacement of the adjacent nerve roots. These were also present on the prior exam and have remained stable. One on the left side measures 16 x 17 mm axial dimensions and one on the right side measures 15 x 15 mm axial dimensions.No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is bilateral facet hypertrophy present associated with a diffuse disc bulge and some endplate reactive changes. Endplate reactive changes are relatively lower signal on T1 and some higher signal on T2 and predominate on the right side. There is some associated vague signal enhancement associated with the endplate reactive change. Endplate reactive changes were not present on the prior exam Since prior exam there has been further loss of disc space height. There are some effacement of the fat at the right lateral recess which was also present on the prior exam. There are some encroachment of the nerve roots of the right lateral recess which is unchanged since the prior exam. The exiting nerve roots within the neural foramina are surrounded by fat.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of bilateral facet and ligamentum flavum hypertrophy present at this level which was also present on the prior exam as well. There is mild anterior subluxation of L4 on L5.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a mild degree of facet and ligamentum flavum hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is redemonstration of a small left renal cortical cyst along the superior medial aspect of the left kidney. It remains stable.
1.There are degenerative changes present in the lumbar spine which are worse at L5-S1 where there is some encroachment of the nerve roots at the right lateral recess due to combination of a disc bulge and facet hypertrophy. There is been minimal progression of this encroachment however there is been progression of loss of disc space height at this level and some subacute endplate reactive changes.2.There are moderate-sized Tarlov cysts present in the sacral spinal canal.3.Postradiation treatment changes in the midthoracic spine. 4.Some interstitial thickening is present in the right lung. Please refer to chest CT from August 26 2015 for further comments.