Expert: CONNIE FOWLER - 2/10/2008

Question
Can you explan all of this to me and maybe what I should do
and what is degeneratve sclerosis billaterally in the pars interarticularis.
I have had back pain for years and it is gettng bad it goes in to both legs on the left it goes down to the knee or the right it goes to the big toe what can help?I go to a pain Dr. but all the meds he gives me does not help I am on Hydromorphon 4mg every 12  hours.

I had a MRI in 2006 and this is it
There is a grade 1 anterolisthesis of L4-L5 with a hemanioma in the L2 vertebral body, The conus medullaris terminates at the level of L1-L2 and shows normal signal. This is suggesttion or a small
synovial cyst posterior to the bilateral L4-L5 facet articulation.Mild bone marrow edema adjacent to the facet articulations at L4-L5 and L5-S1 are likely related to sever degenerative/ arthritic changes.
Mild T2 hyperintensity in the paravertebral soft tissues adjacent to the left L4-L5 facet articulation likely represents represents reactive change as well.
At L1-L2 level no central canal or foraminal compromise.
At L2-L3 level no central canal or foraminal compromise

At the L-3-L4 level there is minmal bulge asmmetrically prominent to the right side. Central canal shows no significant compromise, Neural foramina show minimal narrowing bilaterally. There may be a right posterolateral annular tear.

At the L4-L5 level there is a diffuse disc bulge associated with bilateral facet and ligamentum flavum hypertrophy. There is mild central canal stenosis at this level. There is mild left neural foraminal narowing. The right neural foramen remains patent.

At the L-5-S1 level there is a mild diffuse disc bulge associated with a posterior annular tear. the central canal is not stenotic. There is a mild neural forminal narrowing. The right neural foramen remains patent.

1. Atthe L4-L5 level there in mild central canal stenosis secondary to disc bulge, ligamentum flavum hypertrophy as well as severe facet hypertrophic degeneraive change bilaterally

2. Grade 1 anterolisthesis of the L4 and L5

that was the mri in 2006. in Sept 2006 I was in a bad wreck and my seats broke in the van my  back
just got worse after that so they dod a MRI this month

Here is what it shows Feb 3,2008

There is a grade 1 anterolisthesis of L4 on L5, less then 5mm. the rest of the lumbar spine is well aligned, Vertebral  bodies are intact without destructive lesionsor compression fractures. Marrow signal is normal.
Conus medullaris termiunates at L1.

T12-L1, L1-L2, L2-L3, and L3-L4 have patent spinal canal and neural foramina

L4- L5 has a disc bulge. There are degenerative changes in the facet and ligamentum flavum. Spinal canal and neural foramina are patent. There is degeneratve sclerosis billaterally in the pars interarticularis without a clear spondylolysis.

l5-S1 has patent spinal canal and neural foramina. There are degenerative changes in thefacet and ligamentum flavum.

Impression
1. No Spinal Canal or neural foraminal stenosis.
2. Multilevel degenerative changes, worse at L4-L5 with stable grade 1 spondylolisthesis  

Answer
Hi Rose thank you for your question.
Multilevel degenerative changes, worse at L4-L5 .The phrase "degenerative changes" in the spine refers to osteoarthritis of the spine. Osteoarthritis is the most common form of arthritis. Doctors may also refer to it as degenerative arthritis or degenerative joint disease. grade 1 spondylolisthesis.. The amount of slippage is graded on a scale from 1 to 4. Grade 1 is mild (20% slippage), while grade 4 is severe (100% slippage).
Bone hemangiomas are benign, malformed vascular lesions,

I hope this helps. Best regards, C.L.Fowler