Evaluate for lumbar spine spondylolisthesis and nerve compression. Bilateral hip arthroplasties. Now with left-sided hip and posterior buttock pain radiating down to anterior thigh. Five lumbar type vertebral bodies are presumed to be present as previous. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L4 on L5 similar to prior as well as minimal retrolisthesis of L5 on S1, also similar to prior in the supine position. Bone marrow signal is benign. The conus medullaris is at the lower limits of normal at the L2-L3 level.Multilevel degenerative changes are seen, as described below:Again seen are disc bulges at T10-T11 and T11-T12 which are imaged only on the sagittal sequences and are associated with mild spinal canal stenosis and mild to moderate bilateral neural foraminal stenosis.T12-L1: There is a disc bulge with bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.L1-L2: Mild disc bulge and facet arthropathy. No significant spinal canal or neural foraminal stenosis.L2-L3: Minimal disc bulge and facet arthropathy. No significant spinal canal or neural foraminal stenosis.L3-L4: There is disc bulge eccentric to the right which partially effaces the right lateral recess and extends to the neural foramen. There is mild central canal stenosis and mild to moderate right neural foraminal stenosis. Left neural foramen is patent.L4-L5: Grade 1 anterolisthesis as above. There is disc height loss and vacuum phenomena. There is advanced facet arthropathy as well as ligamentum flavum thickening. There is moderate right neural foraminal stenosis which is slightly worse. There is also mild left neural foraminal stenosis which is also slightly worse. There is moderate degree of spinal canal stenosis similar to prior. L5-S1: Severe disc height loss, bilateral facet arthropathy, and mild disc bulge. There is no significant central spinal canal stenosis. There is moderate to severe left and moderate right neural foraminal stenosis similar to prior. Endplate osteophytes involving the neural foramina, worse on the left, are better seen on CT.
Multilevel degenerative changes in the lumbar spine which are stable to minimally worse compared to prior MRI from 11/14/2011. There is degenerative grade 1 spondylolisthesis at L4-L5 which is similar to prior and can be further assessed with dynamic radiographs. There is moderate degree of spinal canal stenosis at L4-5 level. There is also moderate to severe left L5-S1 neural foraminal stenosis. Additional levels of stenoses as detailed above.