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Date : 00.00.00

Name of the Patient : Abc Xyzbanu Chaudlmn / F / 45 yrs.
Referred by : Dr. Abc Xyz Ansari.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the RLE with wasting since 1 year.

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 a small posterior disc herniation at the L4-L5 level with anterior indentation of the thecal sac and bilateral neural foraminal narrowing. The L4-L5 facet joint on the right side shows degenerative change with indentation upon the right L4 nerve root.

Bilateral small postero-lateral disc bulges are seen at the L2-L3 and L3-L4 levels with mild corresponding neural foraminal narrowing.

Anterior disc herniations are noted at the L2-L3, L3-L4 and L4-L5 levels. These intervertebral discs show loss of water content.

Slight ligamentum flavum hypertrophy is seen at the L5 level.

Hemangioma with fatty content is seen in the L3 vertebral body with focal fatty changes in the upper lumbar vertebrae.

The rest of the lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The rest of the facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
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The conus medullaris terminates at the L1 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 :

12.0 mm at L1-L2
12.0 mm at L2-L3
15.0 mm at L3-L4
15.0 mm at L4-L5
15.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of :

1. A small posterior disc herniation at the L4-L5 level with
facetal arthropathy on the right side and indentation upon the right L4 nerve root.

2. Bilateral small postero-lateral disc bulges at the L2-L3 and L3-L4 levels with mild corresponding neural foraminal narrowing.

3. Slight ligamentum flavum hypertrophy at the L5 level.









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