Date : 00.00.00
Name of the Patient : Abc Xyz lmn / M / 26 yrs.
Referred by : Dr. Abc Xyzagwati.
Examination : M.R.I. of the Dorso-lumbar Spine.
CLINICAL PROFILE :
H/O RTA on 00.00.00 with paraplegia and bladder involvement which recovered within a month.
Now C/O numbness in the right sole and no control over bladder/bowel since then.
M.R.I of the dorso-lumbar 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 anterior wedging of the L1 vertebral body with a kyphus at that level. The anterior half of the L1 body shows an ill-defined, hypointense signal on all pulse sequences which may suggest sclerosis. Focal fatty changes are also noted in the L1 vertebral body. The D12-L1 and L1-L2 intervertebral discs are reduced in height and show loss of water content
The L1 vertebral body is slightly retropulsed with resultant indentation on the anterior dural theca at that level. Slight compromise of the spinal canal at L1 is noted.
Subtle hyperintense signal on the T2 Weighted images is noted along the postero-lateral margin of the dorsal spinal cord, on the right at the D12 vertebral level (scan 105.13). There is no significant cord compression.
The rest of the visualized dorso-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-L1 level.
Screening, T2 weighted sagittal images of the dorsal spine do not reveal any significant feature of note.
Slight anterior wedging of the L1 vertebral body with altered signal as described suggests an old healed fracture. Slight retropulsion of body of L1 is noted with mild compromise of lumbar canal at that level. The adjacent intervertebral discs are degenerated. There is no significant cord compression.
Altered signal in the dorsal spinal cord at D12, on the right, posteriorly, may be the sequelae of previous cord contusion.
As compared to the previous MRI dated 13.04,98, there is a significant decrease in the cord signal alteration on the present study. The L1 vertebral body shows evidence of a healing fracture.