Date : 00.00.00
Name of the Patient : Abc Xyzndra Dhailmn / M / 72 yrs.
Referred by : Dr. Abc Xyzhtekar.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the LLE with paresthesias since 2-3 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 scoliosis of the lumbar spine with convexity to the left side.
There is evidence of an extramedullary (extradural with a probable intradural component) mass lesion measuring approximately 1.1 x 2.5 x 1.8 cms and located within the spinal canal on the left side at the D12 level. It is seen to be extending into and enlarging the left neural foramen at the D12-L1 level. The conus medullaris at the D12 level is compressed and displaced to the right. It also shows a subtle hyperintense signal on the T2 Weighted images and this may represent edema/ischemia. This lesion is hyperintense to normal cord on the T1 Weighted images and appears iso to hyperintense to normal cord on the T2 Weighted images.
A posterior disc herniation with small peridiscal osteophytes is seen to indent the thecal sac and narrow both neural foramina at the L3-L4 level. Type I/II/III degenerative changes are seen within the L3 and L4 vertebral bodies adjacent to the L3-L4 intervertebral disc.
Posterior disc bulges with small peridiscal osteophytes are noted at the L2-L3, L4-L5 and L5-S1 levels. There is mild bilateral neural foraminal narrowing at the L4-L5 level.
Left postero-lateral and left far lateral disc herniations are seen to narrow the left neural foramen and indent the exiting left L5 nerve root at the L5-S1 level. Left far lateral (extraforaminal) disc herniations are noted at the L2-L3 and L3-L4 levels. A right far lateral (extraforaminal) disc bulge is noted at the L3-L4 level.
The L2-L3, L3-L4, L4-L5 and L5-S1 facet joints show degenerative changes.
Anterior disc herniations are seen at the L2-L3, L3-L4 and L4-L5 levels.
The lumbar intervertebral discs show loss of water content.
The rest of the lumbar vertebral bodies reveal normal signal intensity. The rest of the facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
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 :
16.0 mm at D12-L1
17.0 mm at L1-L2
18.0 mm at L2-L3
17.0 mm at L3-L4
16.0 mm at L4-L5
14.0 mm at L5-S1.
- 3 - Scan-00000
The MRI features are suggestive of :
1. An extramedullary (extradural with a probable intradural component) mass lesion measuring approximately 1.1 x 2.5 x 1.8 cms and located within the spinal canal on the left side at the D12 level
with altered signal in the conus (edema/ischemia) as described. This most likely represents a neurofibroma (less likely to be a meningioma).
2. A posterior disc herniation with small peridiscal osteophytes at the L3-L4 level.
3. Posterior disc bulges with small peridiscal osteophytes at the L2-L3, L4-L5 and L5-S1 levels.
4. Left postero-lateral and left far lateral disc herniations at the L5-S1 level indenting the exiting left L5 nerve root at the L5-S1 level.
5. Left far lateral (extraforaminal) disc herniations at the L2-L3 and L3-L4 levels.
6. Facetal arthropathy at the L2-L3, L3-L4, L4-L5 and L5-S1 levels.
A contrast enhanced scan would be worth while.