Name of the Patient : Abc Xyzlmn / M / 63 yrs.
Referred by : Dr. Abc Xyznshah.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the LLE.
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 loss of water content of the lumbar intervertebral discs.
There is a slight forward translation of the L4 over the L5 vertebra without obvious spondylolysis.
There is a posteriorly herniated disc at the L4-L5 level with thecal sac compression. An intermediate signal intensity soft tissue lesion on the T1 Weighted images is noted in the left lateral epidural space at the L4 vertebral level. This lesion appears hyperintense on the T2 Weighted images. Resultant thecal sac compression and indentation on the traversing left L4 nerve root is noted. The facet joints at the L4-L5 level show hypertrophic degenerative changes bilaterally with minimal facet joint effusion on the left.
Small posterior disc herniations with peridiscal osteophytes are noted at the L2-L3 and L3-L4 levels indenting the dural theca anteriorly. There is bilateral neural foraminal narrowing at these levels.
The facet joints at the L3-L4 and L5-S1 levels show degenerative changes.
The lumbar vertebral bodies show spotty fatty marrow changes. The visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the L1 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 :
14.0 mm at L1-L2
10.0 mm at L2-L3
10.0 mm at L3-L4
8.0 mm at L4-L5
12.0 mm at L5-S1.
Screening T1 Weighted coronal images of the hip joints and sacro-iliac joints do not reveal any significant feature of note.
1. Slight forward translation of the L4 over the L5 vertebra without obvious spondylolysis.
2. A posteriorly herniated disc at the L4-L5 level with thecal sac compression. A soft tissue lesion at the L4 vertebral level indenting the traversing left L4 nerve root most likely represents a sequestered disc fragment. The possibility of a nerve sheath tumor seems less likely.
3. Hypertrophic facetal arthropathy at the L4-L5 level bilaterally with minimal facet joint effusion on the left.
4. Small posterior disc herniations with peridiscal osteophytes at the L2-L3 and L3-L4 levels.
5. Facetal arthropathy at the L3-L4 and L5-S1 levels.
6. Tight lumbar canal at the L2-L3, L3-L4 and L4-L5 levels.