This 70-year-old male patient complains of lower back and right hip pain, measured at 3/10. Occasionally, the patient experiences symptoms of radiculopathy down the right leg.
Observe the sclerotic appearance of the dome of the sacral promontory. This sclerotic appearance is unrelated in osteoblastic activity from neoplasm but rather a stress related phenomenon. The disc space narrowing at the L5/S1 level is advanced placing a significant amount of stress upon the anterior sacral promontory, which allows subchondral degenerative sclerosis to occur. Notice, there is a double degenerative spondylolisthesis with a slight anterior displacement at L3 upon L4 and L5 upon the sacrum. Degenerative spondylolisthesis has been defined by Hadley as spondylolisthesis with an intact neural arch. Degenerative spondylolisthesis is seen most frequently in females over the age of 40 and often obese. This follows the “3 F signs” of degenerative spondylolisthesis: Females over Forty and Fat (apology offered). Note also, mild atherosclerosis present in the abdominal aorta.
Yochum and Rowe, Essentials of Skeletal Radiology, Masqueraders of Musculoskeletal Disease, Chapter 18 Lippincott, Williams and Wilkins, 2005.