Name of the Patient : Abc Xyz Almn / M / 19 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the RLE since 5 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 alteration of the normal lumbar lordotic curve.
There are areas of hypointensity on the T1 Weighted images which turn subtly hyperintense on the T2 Weighted images within the pedicle and articular facet of the L5 vertebra on the right side. A small portion of the postero-superior aspect of the L5 vertebral body on the right side is similarly involved incontinuity. There is probable inflammation of the exiting right L5 nerve root within the neural foramen. The left posterior articular pillar of L5 shows areas following fat signal intensity.
Small posterior disc bulges with peridiscal osteophytes are noted at the D11-D12, L1-L2 and L5-S1 levels. Bilateral far lateral disc bulges are noted at the L5-S1 level.
The L4-L5 and L5-S1 facet joints show degenerative changes.
The rest of the lumbar vertebral bodies and the intervertebral discs reveal normal signal intensity. The remaining facet joints and 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 :
17.0 mm at L1-L2
16.0 mm at L2-L3
18.0 mm at L3-L4
17.0 mm at L4-L5
16.0 mm at L5-S1.
The MRI features are suggestive of areas of altered signal within the pedicle and articular facet of the L5 vertebra on the right side with inflammation of the right L5 nerve root and this is not specific for a single etiology.
The possibilities to be considered are :
1. An infective process like tuberculosis.
2. A neoplastic process (less likely).
A high resolution CT Scan may be useful through the area.