The patient presented here is a 30-year-old woman with isthmic spondylolisthesis L5 on S1 with bilateral spondylolysis L5. Since about one year the patient suffers from increased pain, especially during rotation, inclination and reclination. There is no trauma. Radiation mainly into the lateral thigh and lower leg on the right side, to a lesser extent also into the lateral thigh on the left side.
Segmental instability was suspected but could not be demonstrated or excluded on supine MRI.
The patient then underwent upright MRI, both supine and upright, in reclination and in inclination.
A-C: Sagittal images in the sitting position: Inclination, neutral position, reclination
D: Parasagittal image, reclination in sitting position, clearly visible foraminal stenosis.
E: Parasagittal image, inclination in sitting position.
F: Sagittal image in supine position
Diagnosis: Marked anterolisthesis of L5 with bilateral spondylolysis L5. The lack of change in ventral displacement in supine, sitting, and in inclination and reclination argues against the presence of segmental instability. In reclination, an increase in foraminal stenosis is visible on the right side at L5-S1 compared to the inclination position, so that an intermittent irritation of the L5 nerve root is possible.