Date : 00.00.00
Name of the Patient : Abc Xyz Rlmn / F / 65 yrs.
Referred by : Dr. Abc Xyzli.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache radiating to BLE with numbness since 6 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 are posterior peridiscal osteophytes at the L1-L2, L2-L3, L3-L4 and L4-L5 levels with anterior indentation of the thecal sac. Small posterior disc bulges are also noted at these levels. There is mild bilateral neural foraminal narrowing at the L2-L3 and L3-L4 levels.
A small posterior disc bulge is seen at the L5-S1 level.
The lumbar facet joints show degenerative changes.
Anterior disc herniations are seen over the L1-L2 to L4-L5 levels. The L2-L3 and L4-L5 intervertebral discs are reduced in height. The lumbar intervertebral discs show loss of water content.
Lateral peridiscal osteophyte are seen in the lumbar region.
The lumbar vertebral bodies reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S2 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
16.0 mm at L1-L2
17.0 mm at L2-L3
14.0 mm at L3-L4
15.0 mm at L4-L5
13.0 mm at L5-S1.
The MRI features are suggestive of posterior disc bulges with posterior peridiscal osteophytes at the L1-L2, L2-L3, L3-L4 and L4-L5 levels.