Name of the Patient : Abc Xyz Plmn / M / 30 yrs.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache since 1 month.
Alleged H/O RTA, 10-15 years ago.
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.
Areas of hypointensity on the T1 Weighted images which turn mildly hyperintense on the T2 Weighted images are seen to involve the L4 and L5 vertebral bodies. There is extension of this pathologic process into the anterior epidural space at the L4 level and paravertebral soft tissues at the L5 level and into the L4-L5 neural foramina. Also seen is extension into the right psoas muscle (probably an abscess) at the L5 level.
A postero-central disc herniation with peridiscal osteophytes is seen to indent the thecal sac at the L5-S1 level. Also seen is a small postero-central disc herniation with peridiscal osteophytes at the L4-L5 level.
The L4-L5 and L5-S1 intervertebral discs show loss of water content.
The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The facet joints are unremarkable.
The conus medullaris terminates at the D12-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 :
18.0 mm at L1-L2
17.0 mm at L2-L3
16.0 mm at L3-L4
12.0 mm at L4-L5
11.0 mm at L5-S1.
The MRI features are suggestive of :
1. A pathologic process involving the L4 and L5 vertebrae with soft tissue extensions as described. This most likely represents an infective process like tuberculosis (less likely to be a neoplastic process).
2. A postero-central disc herniation with peridiscal osteophytes at the L5-S1 level.
3. Small postero-central disc herniation with peridiscal osteophytes at the L4-L5 level.