Name of the Patient : Abc Xyzbi Shlmn / F / 68 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain radiating to BLE with paresthesias.

EXAMINATION :

M.R.I. of the lumbo-sacral spine was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

There is loss of normal lumbar lordosis and loss of water content of the lumbar-intervertebral discs. There is mild scoliosis of the lumbar spine with convexity to the right and slight anticlockwise rotational anomaly of the upper lumbar vertebrae.

There is a small posterior disc herniation at the L4-L5 level, minimally indenting the traversing S1 nerve roots bilaterally.

A posteriorly herniated disc with peridiscal osteophytes is noted at the L4-L5 level with thecal sac compression and bilateral neural foraminal narrowing. A part of the disc fragment is noted in the right neural foramen at the L5-S1 level, indenting the exiting right L4 nerve root.

A posteriorly herniated disc with peridiscal osteophytes is noted at the L3-L4 level with thecal sac compression and bilateral neural foraminal narrowing.


Posteriorly bulging disc with peridiscal osteophytes are noted at the D12-L1, L1-L2 and L2-L3 levels.

Bilateral far-lateral disc bulges with peridiscal osteophytes are noted at the L2-L3, L3-L4, L4-L5 and L5-
S1 levels.

Facetal hypertrophy is noted at the L3-L4, L4-L5, L5-S1 levels, with ligamentum flavum hypertrophy at the L4-L5 level.

There is slight anterior wedging of the L2 and L4 vertebral bodies.

The lumbar vertebral bodies show spotty fatty marrow changes. The visualized pre and paravertebral soft tissues are unremarkable.

There is a well marginated, hyperintense signal on all pulse sequences in the left psoas muscles, posteriorly, over L2 and L3 levels, which follows fat signal on all pulse sequences, ? intramascular lipoma.

The conus medullaris terminates at the L1 level and the thecal sac terminates at the S2 level.

The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :

9.0 mm at L1-L2
10.0 mm at L2-L3
6.0 mm at L3-L4
8.0 mm at L4-L5
8.0 mm at L5-S1.

Screening, T2 weighted sagittal images of the dorsal spine reveal slight facetal hypertrophy in the lower dorsal region.
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IMPRESSION :

1. A small posterior disc herniation at the L5-S1 level, minimally indenting the traversing S1 nerve roots bilaterally.

2. A posteriorly herniated disc with peridiscal osteophytes at the L4-L5 level with a part of the disc fragment in the right neural foramen at the L4-L5 level, indenting the exiting right L4 nerve root.

3. A posteriorly herniated disc with peridiscal osteophytes at the L3-L4 level.

4. Posteriorly bulging discs with peridiscal osteophytes at the D12-L1, L1-L2 and L2-L3 levels.

5. Bilateral far-lateral disc bulges with peridiscal osteophytes at the L2-L3, L3-L4, L4-L5 and L5-
S1 levels.

6. Facetal hypertrophy at the L3-L4, L4-L5, L5-S1 levels, with ligamentum flavum hypertrophy at the L4-L5 level.

7. Osteoporotic changes in the lumbar vertebrae with slight anterior wedging of the L2 and L4 vertebral bodies.

8. A probable intramascular lipoma in the left psoas over L2 and L3 vertebral levels.

9. Lumbar canal stenosis at the L3-L4 and L4-L5 levels.