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ke/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc XyzPratappurlmn / M / 41 yrs.
Referred by : Dr. Abc Xyzli.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE since 3 months.

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 straightening of the lumbar spine with probable sacralization of the L5 vertebra. (Please correlate with plain radiographs). The L5 vertebra appears as marked on the film.

A large posterior disc extrusion with peridiscal osteophytes is seen at the L4-L5 level with severe compression of the thecal sac and canal stenosis. There is inferior migration of the disc with indentation upon the traversing L5 nerve roots.

The L4-L5 intervertebral disc shows loss of water content.

Type II degenerative changes are noted in the L4 and L5 vertebral bodies adjacent to the L4-L5 disc.

The L3-L4 facet joint on the left side shows degenerative changes.
Scan-00003


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.

The conus medullaris terminates at the D12 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 L1-L2
16.0 mm at L2-L3
14.0 mm at L3-L4
4.0 mm at L4-L5
10.0 mm at L5-S1.

IMPRESSION :

1. Probable sacralization of the L5 vertebra (Please correlate with plain radiographs).

2. A large posterior disc extrusion with peridiscal osteophytes and severe canal stenosis at the L4-L5 level. There is inferior migration of the disc with indentation upon the traversing L5 nerve roots.


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