Date : 00.00.00
Name of the Patient : Abc Xyzsalmn / M / 36 yrs.
Referred by : Dr. Abc Xyzchant / Dr. Abc Xyzthwani
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache radiating to the RLE since 3 months.
H/O fall from a height with fracture of the L2 vertebra.
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 partial sacralization of the L5 vertebra on the left side.
There is a fracture of the L2 vertebral body without any signal change.
Small posterior peridiscal osteophytes are noted at the L1-L2 and L2-L3 levels with mild anterior indentation of the thecal sac.
A small posterior disc bulge is seen at the L4-L5 level with ventral indentation upon the thecal sac.
The facet joints at the L3-L4 and L4-L5 levels show hypertrophy.
The lumbar vertebral bodies and the intervertebral discs 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 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 :
18.0 mm at L1-L2
17.0 mm at L2-L3
17.0 mm at L3-L4
15.0 mm at L4-L5
13.0 mm at L5-S1.
1. Partial sacralization of the L5 vertebra on the left side.
2. Fracture of the L2 vertebral body without any signal change.
3. Small posterior peridiscal osteophytes at the L1-L2 and the L2-L3 levels.