Name of the Patient : Abc Xyzllah Chaudlmn / M / 63 yrs.
Referred by : Dr. Abc Xyzolakia.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain radiating to RLE.
C/O decompression with laminectomy at the L4-L5 level.

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 water content of all the lumbar intervertebral discs.

There is evidence of laminectomy at the L4 vertebral level with post-operative changes in the soft tissues in the posterior lumbar region at that level.

There is minimal forward translation of the L4 over the L5 vertebra without obvious spondylolysis.

There is a posteriorly herniated disc at the L4-L5 level with thecal sac compression and bilateral neural foraminal narrowing. There is an intermediate signal intensity lesion on the T1 Weighted images around the thecal sac at the L4-L5 level which appears hyperintense on the T2 Weighted images. Effacement of the epidural fat is noted. This may represent scar tissue, the sequelae of previous surgery.


The exiting L4 nerve roots through the neural foramen at the L4-L5 level also appears slightly thickened, ? due to scar tissue, ? inflamed nerve roots, ?? sequestered disc fragment.

There is also hypertrophic facetal arthropathy and resultant lateral recess stenosis at the L4-L5 level. Bilateral far lateral disc herniations are also noted at the L4-L5 level indenting the extraforaminal segments of the L4 nerve roots.

The intrathecal nerve roots at the L4 and L4-L5 levels appear clumped, suggesting arachnoiditis.

Small posterior disc bulges are noted at the L2-L3 and L3-L4 levels and a small postero-central protruded disc is noted at the L5-S1 level.

Small posterior disc bulge with peridiscal osteophytes is noted at the L1-L2 level.

The rest of the facet joints in the lumbar region appear hypertrophied.

The pedicles of the lumbar vertebrae appear congenitally short in their antero-posterior dimensions.

A hemangioma with fat content is noted in the L3, L4 and L1 vertebral bodies.

The rest of the lumbar vertebral bodies reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the D12-L1 level and the thecal sac terminates at the S1 level.
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- 3 - Scan-00002

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

13.0 mm at L1-L2
12.0 mm at L2-L3
10.0 mm at L3-L4
9.0 mm at L5-S1.

Incidentally noted is a fairly large cortical renal cyst on the right.

IMPRESSION :

1. Post-operative status.

2. Minimal forward translation of the L4 over the L5 vertebra without obvious spondylolysis.

3. A posteriorly herniated disc at the L4-L5 level with hypertrophic facetal arthropathy and resultant lateral recess stenosis at this level.

4. Altered signal around the thecal sac at the L4-L5 level with effacement of the epidural fat may represent scar tissue.

5. Thickened exiting L4 nerve roots through the neural foramen at the L4-L5 level may be due to ? scar tissue, ? inflamed nerve roots, ?? sequestered disc fragment.

6. Clumped intrathecal nerve roots at the L4 and L4-L5 levels suggests arachnoiditis.

7. Bilateral far lateral disc herniations at the L4-L5 level indenting the extraforaminal segments of the L4 nerve roots.
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- 4 - Scan-00002

8. Facetal hypertrophy in the rest of the lumbar region.

9. Congenitally short pedicles of the lumbar vertebrae in their antero-posterior dimensions.

As compared to the previous MRI (study no:00008) dated 00.00.0000, the patient is status post-operative. The previously identified sequestered disc fragment is not noted on the present study. Scar tissue is noted around the thecal sac at the operative site.

A contrast enhanced study would be worthwhile.