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ke/bv/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyzanoo Shalmn / F / 40 yrs.
Referred by : Dr. Abc Xyzhari.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache since 5 years.
C/O radicular pain to the LLE with paresthesias since 6 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 :

The L4-L5 and L5-S1 intervertebral discs show loss of water content.

There is a small postero-central disc herniation at the L5-S1 level with anterior indentation of the thecal sac. A left far lateral disc bulge is also noted at this level.

A small posterior and a left far lateral disc bulge is seen at the L4-L5 level with anterior indentation of the thecal sac.

The L2-L3, L3-L4, L4-L5 and L5-S1 facet joints show mild degenerative changes.

Type II degenerative changes are noted in the antero-superior aspect of the L3, L4 and L5 vertebral bodies. Anterior peridiscal osteophytes are seen in the lower lumbar region.



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 :

16.0 mm at L1-L2
16.0 mm at L2-L3
16.0 mm at L3-L4
20.0 mm at L4-L5
11.0 mm at L5-S1.

IMPRESSION :

1. A small postero-central disc herniation at the L5-S1 level.

2. A small posterior and a left far lateral disc bulge at the L4-L5 level.

3. Mild facetal arthropathy at the L2-L3, L3-L4, L4-L5 and L5-S1 levels.


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