Question
QUESTION: What is degeneratve sclerosis billaterally in the pars interarticularis and how do you get it
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: Dear Rose,

I understand that your MRI reports can be confusing and frustrating, however, they are actually very simple to understand if you have the terminology down or if you can actaully see the anatomy involved while reading the report.  Without giving you a vocabulary lessen, I will try to give you the highlights of the reports.

September 2006:  
Degenerative sclerosis means that there are arthritic changes of the bones, the more degeneration there is, the more calcium is being deposited in that area of the spine.  The pars interarticularis is a specific area of the vertebra on the back side near where the nerve roots exit the spine, and is a common site for fracture or non-union of growth centers. It is on bosth sides of the vertebra. In your case the cause of the dysfunction has not been specifically determined in the report(other than degeneration/wear and tear).

Hemangiomas are benign bone tumors that are often found in the spine.  They can weaken the bones, but are normally not ever problematic.  We tend to find them incidentally, and often people have them present for decades without any issues.  Their potential for becomming cancerous is very small

Facet articulations are just the joint spaces in the spine.  The areas of L4/L5/S1 have significant degeneration and this can create increased low back pain...probably chronic.

You have three bulging disks, one being significant at L4/L5 and more prominent to the left side narrowing the space where the nerves exit the spine.  This can create local pain and pain down the Left leg below the knee.  Also significant at L5/S1, with the outside portion of the disk being torn.  This can create significant local pain, but not usually down the legs, as the nerve roots do not seem to be affected.

Ligamentum Flavum is a ligament that is located inside the spinal canal.  Yours has undergone some overgrowth, this is usually due to irritation and scar tissue build-up, and can place pressure on the spinal cord.  On your report the spinal cord has less room to move inside the spinal canal, but does not seem to be compressed.

The grade 1 antrolisthesis means that the L4 vertebra has slipped forward on the vertebra below, but less than 25% forward.  The degenerative type is the most common, and is most common at the spinal level you have it.  There does not appear to be a fracture here, so this is considered stable.

Now, the 2008 MRI doesn't show any significant changes from the 2006 version, with the exception that the disk bulges seem to have improved somewhat.  This could mean that there is an actual improvement, or that the radiologist has just read the films differently.

Rose, I understand that this may still seem very complicated to you, so I want you to take a bit of time and look over my website.  There is a glossary section where you can look up the meanings to all of these terms, and there are three pages of anatomical pictures with full descriptions so you can better appreciate the structures involved.  I also have an entire page dedicated to disk bulges/herniations so that you can get a better appreciation of that as well.  Please review the information on the website, and then feel free to write back if you have further questions.  Hope this helps.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net

---------- FOLLOW-UP ----------

QUESTION: What is degeneratve sclerosis billaterally in the pars interarticularis and how do you get it


Answer
Dear Rose,

I already answered this question in the first paragraph of the last response, so I would suggest that you re-read it, however, I understand the terminology may be confusing so I will try to give you a slightly different explanation.  

Sclerosis is a term for degenerative calcium deposition in the pars location. It is termed sclerosis as it is visualized by a white thickening on x-rays, and may have irregular borders rather than smooth. The pars is a specific element of the vertebra located on the posterior aspect and it is a bilateral structure that is commonly the source of degeneration due to overuse injury and fracture, or a non-union of growth centers of the vertebra from childhood.

I am not exactly sure what you are not understanding about the response, but it can be difficult to describe the anatomy in words, which may result in difficulty understanding my explanation.  So, you may wish to consult an anatomy textbook...focus on the structure of the vertebra in the lumbar spine.  After 20 minutes of Internet searching, I was actually able to find a decent pars illustration and have copied the link below for you to appreciate.

http://www.fotosearch.com/LIF127/3d709006/

This may be just a glitch in the allexperts system which sent your original question back to me.  However, if not please feel free to write back again if I have not clarified your understanding. Please try to be more specific with your question so that I can be more specific with my answer.  Hope this helps Rose.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net