Date : 00.00.00
Name of the Patient : Abc XyzS. Kachlmn / M / 31 yrs.
Referred by : Dr. Abc Xyzauhan.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache radiating to the RLE with paresthesias since 3 1/2 months.
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 is slight retroplacement of the L4 over the L5 vertebra and
loss of water content of the L4-L5 intervertebral disc.
There is a fairly large, postero-central and right paracentral extruded disc with peridiscal osteophyte at the L4-L5 level with thecal sac compression. Slight inferior migration of the disc fragment is noted indenting the traversing L5 nerve roots, more on the right side.
A minimal, postero-central protruded disc is noted at the L5-S1 level.
The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the D12 level and the thecal sac terminates at the S1 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
15.0 mm at L1-L2
16.0 mm at L2-L3
16.0 mm at L3-L4
13.0 mm at L4-L5
14.0 mm at L5-S1.
A fairly large, postero-central and right paracentral extruded disc with peridiscal osteophyte at the L4-L5 level with slight inferior migration of the disc fragment indenting the traversing L5 nerve roots, more on the right side.