Name of the Patient : Abc XyzAgalmn / M / 43 yrs.
Referred by : Dr. Abc Xyzolakia.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the LLE with slight numbness since 2 months.
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 sacralization of the L5 vertebral body and the L4 vertebra is as marked on the film.
The L3-L4 and L4-L5 intervertebral discs show loss of water content.
There is a large postero-central disc extrusion at the L3-L4 level with anterior indentation of the thecal sac. An extruded disc portion is seen to migrate inferiorly lying in the left lateral recess of the L4 vertebral body (se/im 104/8) impinging the traversing left L4 nerve root.
A postero-central and right paracentral disc herniation is seen at the L4-L5 level with anterior indentation of the thecal sac and right neural foraminal narrowing.
The facet joints at the L4-L5 and L3-L4 levels
show degenerative changes. Flavum hypertrophy is noted at the L5 level.
There are Type II degenerative changes in the L4 and L5 vertebral bodies adjacent to the L4-L5 intervertebral disc.
- 2 - Scan-00005
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 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 :
16.0 mm at L1-L2
18.0 mm at L2-L3
14.0 mm at L3-L4
14.0 mm at L4-L5
12.0 mm at L5-S1.
The MRI features are suggestive of :
1. Sacralization of the L5 vertebral body.
2. A large postero-central disc extrusion at the L3-L4 level with an extruded disc portion seen to migrate inferiorly and lying in the left lateral recess of the L4 vertebral body with impingement of the traversing left L4 nerve root.
3. A postero-central and right paracentral disc herniation at the L4-L5 level.