Date : 18.02..99
Name of the Patient : Abc Xyza S. Mlmn / F / 68 yrs.
Referred by : Dr. Abc Xyzhtekar.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backche radiaitng to BLE with paresthesias (right more than left).
H/O spine surgery 16 years back .
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.
There are post-operative changes in the posterior soft tissues over the L2 to the S1 levels with laminectomy of the L3, L4, L5 and S1 vertebrae and partial laminectomy of the L2 vertebra.
There is forward subluxation of the L3 over the L4 and of the L4 over the L5 verterbrae and slight retroplacement of the L1 over the L2 vertebrae.
There are diffuse posterior disc herniations at the L3-L4 and L4-L5 levels with anterior indentation of the thecal sac and bilateral neural foraminal narrowing. Also seen is impingement of the exiting L3 and L4 nerve roots at the L3-L4 and L4-L5 levels, respectively.
The L3-L4 and L4-L5 facet joints show hypertrophic degenerative changes with resultant central and lateral canal stenosis.
Far lateral (extraforaminal) disc herniations are seen at the L3-L4, L4-L5 and L5-S1 levels.
Posterior disc bulges are seen at the L1-L2, L2-L3 and L5-S1 levels with anterior indentation of the thecal sac and mild bilateral neural foraminal narrowing. The L2-L3 facet joints show hypertrophic degenerative changes. Mild facetal arthropathy is noted at the L1-L2 level.
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There appears to be inflammation of the traversing right L5 nerve root and the traversing left S1 nerve root.
The lumbar intervertebral discs show loss of water content. Hypointense areas are seen within the L3-L4 and L4-L5 intervertebral discs on all the pulse sequencs suggestive of calcium/vacuum phenomena.
The pedicles of the lumbar vertebrae appear to be congenitally short in their antero-posterior dimensions.
Fatty changes are noted in the lumbar vertebrae.
Mild central wedging of the D9 vertebral body is seen with a probable hemangioma in the D10 vertebral body. Posterior disc bulges with peridiscal osteophytes are seen at the D9-D10 and D10-D11 levels.
The visualized pre and paravertebral soft tissues are unremarkable.
The intrathecal nerve roots over the L2 to L5 levels appear thick and appear to be centrally placed and would represent Group I/III arachnoids. The intrathecal nerve roots are peripherally plastered at the L5-S1 and S1 levels suggestive of Group II arachnoids.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S2 level.
The MRI features are suggestive of :
1. Post-operative status.
2. Forward subluxation of the L3 over the L4 and of the L4 over the L5 verterbrae.
3. Diffuse posterior disc herniations at the L3-L4 and L4-L5 levels with impingement of the exiting L3 and L4 nerve roots respectively at these levels .
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4. Hypertrophic facetal arthropathy at the L3-L4 and L4-L5 levels with
resultant central and lateral canal stenosis.
5. Posterior disc bulges at the L1-L2, L2-L3 and L5-S1 levels with hypertrophic facetal arthropathy at the L2-L3 level.
6. Arachnoiditis over the L2 to S1 levels.
7. Probable inflammation of the traversing right L5 nerve root and the traversing left S1 nerve root.