MyPACS.net: Radiology Teaching Files > Case 3831656

previously visited SPONDYLOLYSIS WITH GRADE II SPONDYLOLISTHESIS
Contributed by: Fritsch & Thompson, Radiologist, Diagnostic Radiology of Houston, Texas, USA.
Patient: 56 year old male
History:

R/O disc herniation.

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Findings:

MRI of the lumbar spine reveals the following:

L5-S1: There is mild signal loss of the nucleus pulposus without loss of disc height. Dorsal annular bulging is noted with a curvilinear high intensity zone signal abnormality at the 7:00 position consistent with a partial peripheral annular tear/fissure effacing the traversing right S1 nerve root with mild dorsal displacement (T2 axial image 19, sagittal image 7). In addition, there is mild facet hypertrophy.

L4-L5: There is bilateral spondylolysis with Grade II spondylolisthesis. Advanced degeneration and marked disc space narrowing of the intervertebral disc is noted with Modic Type I and II reactive end plate marrow changes. There is associated facet hypertrophy. There is prominent dorsal and cephalad annular bulging secondary to the spondylolisthesis resulting in lateral recess and neuroforaminal stenosis. Clinical correlation advised for associated radicular involvement.

L3-L4: The intervertebral disc is unremarkable. There is mild facet hypertrophy with small effusions noted in the zygapophyseal joints.
L2-L3: The intervertebral disc has a normal appearance. The spinal canal, neural foramina and contents are well maintained. The posterior elements are unremarkable.

L1-L2: Moderate signal loss of the nucleus pulposus with mild loss of disc height. Anterior and posterior discal bulging measuring 2-3 mm is identified, most pronounced anteriorly with associated end plate spondylosis. There is compression of the thecal sac but no neurological compromise.

T12-L1: The intervertebral disc has a normal appearance. The spinal canal, neural foramina and contents are well maintained. The posterior elements are unremarkable.

There are no compression fractures or marrow lesions within the vertebral bodies. The conus medullaris does not show any intrinsic or extrinsic abnormality. The paraspinal musculature shows mild atrophy and asymmetry in the lumbosacral junction beginning at the level of the spondylolysis and spondylolisthesis of L4-L5. Specifically, there is hypoplasia of the multifidi, right greater than left L4-L5 and L5-S1. Retroperitoneal structures visualized in this examination are unremarkable.

Diagnosis:
  1. MILD DESICCATION OF THE L5-S1 NUCLEUS WITHOUT LOSS OF DISC HEIGHT. ASSOCIATED 7:00 POSITION HIZ AND DORSAL ANNULAR BULGING EFFACES AND MILDLY DISPLACES THE TRAVERSING RIGHT S1 NERVE ROOT WITHOUT SEVERE NEUROCOMPRESSION.
  2. MILD FACET HYPERTROPHY L5-S1.
  3. CHRONIC SPONDYLOLYSIS OF L4 WITH GRADE II SPONDYLOLISTHESIS L4 ON L5. SECONDARY ADVANCED DEGENERATIVE DISC DISEASE WITH ANNULAR BULGING NOTED. THIS RESULTS IN MARKED BILATERAL NEUROFORAMINAL STENOSIS AND MODERATE LATERAL RECESS STENOSIS.
  4. MILD INTERVERTEBRAL OSTEOCHONDROSIS AND ANNULAR BULGING L2-L3 AS DISCUSSED ABOVE.
  5. MILD ATROPHY AND ASYMMETRY OF THE POSTERIOR PARASPINAL MUSCULATURE AT THE LOWER LUMBAR REGION AS OUTLINED ABOVE.
References:

REFERRING PHYSICIAN: DR. SALIMSH CUMBER, MD

Comments:
No comments posted.
Additional Details:

Case Number: 3831656Last Updated: 01-24-2007
Anatomy: Spine and Peripheral Nervous System   Pathology: Trauma
Modality: Conventional Radiograph, MRExam Date: 11-15-2005Access Level: Readable by all users
Keywords: spondylolysis, spondylolisthesis, lumbar spine

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