56-year-old male with history of L4-5 spondylolisthesis with right lower extremity radiculopathy. There is approximately 5 mm of anterolisthesis of L4 on L5 and 6 mm of retrolisthesis of L5 on S1. There are chronic bilateral pars defects at L4. The vertebral body heights are intact. The conus medullaris is mildly low lying, terminating at the level of L2-3. The paraspinous soft tissues are grossly unremarkable. There are multilevel degenerative changes:L1-L2: No significant disc disease. No spinal canal or neuroforaminal stenosis.L2-L3: Mild disc bulge. No spinal canal or neuroforaminal stenosis.L3-L4: Mild disc bulge. No spinal canal or neuroforaminal stenosis.L4-L5: Disc uncovering and bulging with an extruded component extending cranially within the midline ventral epidural space. There is moderate to severe neuroforaminal canal stenosis at this level. No significant spinal canal stenosis. There is also facet arthropathy and a medial subcentimeter right synovial cyst that appears to impinge upon the adjacent nerve roots.L5-S1: There is a disc bulge resulting in moderate bilateral neuroforaminal stenosis. No significant spinal canal stenosis. Moderate facet arthropathy and bilateral facet joint effusions.
1. Bilateral L4 spondylolysis with grade 1 anterolisthesis of L4 on L5 and moderate to severe bilateral neuroforaminal stenosis. Advanced facet arthropathy is present at this level as well, with an associated subcentimeter right synovial cyst.2. An L5-S1 disc bulge results in moderate bilateral neuroforaminal narrowing. Advanced facet arthropathy is present at this level as well.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.