Worsening low back and hip pain. Five lumbar type vertebral bodies are presumed to be present with the most inferior well-defined disc space labeled L5-S1. Vertebral body heights are within normal limits. There is grade 1 anterolisthesis of L3 on L4 which appears slightly worse than prior study from 6/6/2008. Alignment is otherwise maintained. Bone marrow signal is benign. The conus medullaris is normal in position.Multilevel degenerative changes are seen, as described below:L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: Disc desiccation and minimal bulge. There is also ligamentum flavum thickening and bilateral facet arthropathy. No significant spinal canal or neural foraminal stenosis.L3-L4: Grade 1 anterolisthesis with disc uncovering. There is also advanced bilateral facet arthropathy and ligamentum flavum thickening. These findings appear mildly progressed since prior study. There is moderate spinal canal stenosis which appears minimally worse since prior. There is also very mild bilateral neural foraminal narrowing.L4-L5: Mild disc bulge and advanced bilateral facet arthropathy. Minimal spinal canal narrowing. There is moderate left and minimal right neural foraminal stenosis. Left-sided neural foraminal stenosis appears slightly worse.L5-S1: No significant disc disease. No spinal canal or neural foraminal stenosis.Paraspinous soft tissues are within normal limits. There is a focus of low T1 and low T2 signal involving the right aspect of the sacrum measuring approximately 11 mm in diameter, previously approximately 4 mm and 2008. Degenerative changes also noted at the sacroiliac joints.
1. Degenerative changes in the lumbar spine are minimally progressed since 6/6/2008. There is moderate spinal canal stenosis at L3-L4 related to degenerative spondylolisthesis which appears minimally worse. Flexion-extension radiographs may be helpful to assess for instability. There is also moderate left L4-L5 neural foraminal stenosis which appears slightly worse.2. Advanced facet arthropathy at L3-L4 and L4-L5 which may be contributing to patient's low back pain.3. Nonspecific focus of low T1 and low T2 signal involving the right sacrum which is larger since 2008. Finding is favored to represent an enlarging bone island but consider pelvic radiograph for confirmation.