/735 Date : 00.00.00
Name of the Patient : Abc Xyzakant Suralmn / M / 60 yrs.
Referred by : Dr. Abc Xyz. Shah.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache and weakness of BLE.
Alleged H/O fall 1 month back.
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 a collapse of the L1 vertebral body with anterior wedging and a break of its cortical endplates. Areas of hypointensity on all the pulse sequences are seen to involve the L1 vertebral body and pedicles bilaterally. Also seen is extension of this pathologic process into the pre and paravertebral soft tissues and the anterior epidural space with indentation upon the thecal sac over the D12-L1 to L1-L2 levels.
There is mild retroplacement of the L3 vertebra over the L4 vertebra. A small posterior disc herniation is seen to indent the thecal sac and narrow both neural foramina at the L3-L4 level.
Posterior disc bulges are noted at the L4-L5 and L5-S1 levels. The facet joints at these levels show degenerative changes.
Far lateral disc herniations are seen bilaterally at the L3-L4 and L4-L5 levels and on the left side at the L1-L2 and L2-L3 levels.
A Schmorls node is noted at the inferior aspect of the L3 vertebral body. The lumbar intervertebral discs show loss of water content. Type II degenerative changes are noted in the rest of the lumbar vertebral bodies.
Areas of hypointensity on the T1 Weighted images are seen to involve the right iliac bone adjacent to the right sacro-iliac joint. There is superior involvement of the right sacro-iliac joint.
A cortical renal cyst is seen on the left side.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1-S2 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
17.0 mm at D12-L1
19.0 mm at L1-L2
18.0 mm at L2-L3
17.0 mm at L3-L4
15.0 mm at L4-L5
12.0 mm at L5-S1.
The MRI features are suggestive of :
1. A pathologic process involving the L1 vertebra as described and this is not specific for a single etiology. This may represent a neoplastic process like secondaries or small cell tumors (? an infective process like tuberculosis). This is less likely to represent a nonpathologic compression fracture (i.e. post-traumatic), especially in view of another lesion involving the iliac bone on the right side. A biopsy of the lesion would be worthwhile.
2. A small posterior disc herniation at the L3-L4 level.
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3. Posterior disc bulges at the L4-L5 and L5-S1 levels.
4. Far lateral disc herniations bilaterally at the L3-L4 and L4-L5 levels and on the left side at the L1-L2 and L2-L3 levels.
5. Facetal arthropathy at the L4-L5 and L5-S1 levels with a tight canal at these levels.