Name of the Patient : Abc Xyz Charlmn / F / 63 yrs.
Referred by : Dr. Abc Xyz Hashim.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the RLE with paresthesias.
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 mild forward translation of the L4 over the L5 and L3 over the L4 vertebrae. Mild retroplacement of the L1 over the L2 and L2 over the L3 vertebrae is noted.
The lumbar intervertebral discs show loss of water content. Hypointense areas are seen within the L4-L5 intervertebral disc on all the pulse sequences and this may represent calcium/vacuum phenomena.
There appears to be a break of the pars interarticularis of the L4 vertebra on the left side.
A large posterior disc herniation with peridiscal osteophytes is seen to indent the thecal sac and narrow both neural foramina with impingement of the exiting L4 nerve roots at the L4-L5 level.
Bilateral far lateral (extraforaminal) disc herniations are noted at the L3-L4, L4-L5 and L5-S1 levels.
Small bilateral postero-lateral disc herniations are seen to narrow both neural foramina at the L1-L2, L2-L3 and L3-L4 levels.
Small postero-central disc herniations are noted at the L1-L2 and L5-S1 levels.
Bilateral far lateral (extraforaminal) disc bulges are noted at the L1-L2 and L2-L3 levels.
The L3-L4 and L4-L5 facet joints show severe hypertrophic degenerative changes. The L2-L3 facet joints show degenerative changes.
Ligamentum flavum hypertrophy is noted at the L3-L4 and L4-L5 levels.
The pedicles of the lumbar vertebrae appear to be congenitally short in their antero-posterior dimensions.
A limbus vertebra is noted at the L4 level.
Anterior disc herniations with peridiscal osteophytes are noted over the L1-L2 to L4-L5 levels. Type II degenerative changes are seen within the L4 and L5 vertebral bodies adjacent to the L4-L5 intervertebral disc.
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 :
12.0 mm at L1-L2
- 3 - Scan-00002
11.0 mm at L2-L3
7.0 mm at L3-L4
6.0 mm at L4-L5
7.0 mm at L5-S1.
The MRI features are suggestive of :
1. A large posterior disc herniation with peridiscal osteophytes with severe canal stenosis at the L4-L5 level.
2. Bilateral postero-lateral (foraminal) disc herniations at the L1-L2, L2-L3 and L3-L4 levels.
3. Bilateral far lateral disc herniations at the L3-L4, L4-L5 and L5-S1 levels.
4. Severe hypertrophic facetal arthropathy at the L3-L4 and L4-L5 levels.
5. Facetal arthropathy at the L2-L3 level.
6. Congenitally short pedicles of the lumbar vertebrae in their antero-posterior dimensions.
7. Canal stenosis at the L3-L4 level.
8. Break of the pars interarticularis of the L4 vertebra on the left side.