Date : 00.00.00
Name of the Patient : Abc XyzV. Chlmn / M / 46 yrs.
Referred by : Dr. Abc Xyzhari.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache (mid to lowback) with numbness in BLE.
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.
The L1-L2, L3-L4, L4-L5 and L5-S1 intervertebral discs show loss of water content.
A postero-central disc herniation is seen to indent the thecal sac at the L4-L5 level.
Small postero-central disc herniations are seen to indent the thecal sac at the L3-L4 and L5-S1 levels.
There is a postero-central disc protrusion at the L1-L2 level.
The L4-L5 facet joints show mild degenerative changes.
Type II degenerative changes are noted within the postero-inferior aspect of the L1 and L2 vertebral bodies and the antero-superior surface of the S1 vertebra.
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 L1-L2 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 :
17.0 mm at L1-L2
17.0 mm at L2-L3
15.0 mm at L3-L4
10.0 mm at L4-L5
14.0 mm at L5-S1.
1. A postero-central disc herniation with facetal arthropathy at the L4-L5 level.
2. Small postero-central disc herniations at the L3-L4 and L5-S1 levels.