Date : 00.00.00
Name of the Patient : Abc Xyz Fajalmn / M / 39 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O progessive swelling in the lower lumbar region with pain since 2 years.
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.
4 mm thick STIR coronal images through the region of interest.
Vitamen E capsules were placed at the site of swelling.
There is a postero-central disc protrusion with posterior peridiscal osteophytes at the L5-S1 level.
A posterior disc bulge is seen at the L4-L5 level.
Schmorls nodes are noted in the dorso-lumbar region.
The L4-L5 and L5-S1 facet joints on the right side show mild degenerative changes.
The lumbar intervertebral discs show loss of water content.
The lumbar vertebral bodies reveal normal signal intensity. The remaining facet joints and the visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the D12-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 :
18.0 mm at L1-L2
16.0 mm at L2-L3
17.0 mm at L3-L4
16.0 mm at L4-L5
11.0 mm at L5-S1.
No obvious mass lesion is seen in the gluteal region on this scan.
The MRI features are suggestive of :
1. A postero-central disc protrusion with posterior peridiscal osteophytes at the L5-S1 level.
2. Mild facetal arthropathy at the L4-L5 and L5-S1 levels on the right side.