ke/hs/nl/nl
Name of the Patient : Abc Xyzlal Ylmn / M / 43 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the RLE with paresthesias.
EXAMINATION :
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.
OBSERVATION :
There is straightening of the lumbar spine with slight retroplacement of the L4 vertebra over the L5 vertebra.
A large right paracentral extruded disc is seen at the L4-L5 level with compression of the thecal sac, canal stenosis and mild right neural foraminal narrowing. The extruded disc portion is seen to migrate inferiorly into the right lateral recess of the L5 vertebral body as well as superiorly into the right lateral recess of the L4 vertebral body with impingement of the traversing right L4 and L5 nerve roots. The L4-L5 facet joints show hypertrophic degenerative changes.
Small postero-central disc herniations are noted at the L3-L4 and L5-S1 levels. A postero-central disc protrusion is noted at the L2-L3 level. The L3-L4, L4-L5 and L5-S1 intervertebral discs show loss of water content. The L2-L3 intervertebral disc shows mild loss of water content.
The L5-S1 facet joints show mild degenerative changes.
Type II degenerative changes are noted in the L4 and L5 vertebral bodies.
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 L1 level and the thecal sac terminates at the S1-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
16.0 mm at L3-L4
10.0 mm at L4-L5
11.0 mm at L5-S1.
IMPRESSION :
1. A large right paracentral extruded disc at the L4-L5 level with canal stenosis. The extruded disc portion is seen to migrate inferiorly into the right lateral recess of the L5 vertebral body as well as superiorly into the right lateral recess of the L4 vertebral body with impingement of the traversing right L4 and L5 nerve roots.
2. Small postero-central disc herniations at the L3-L4 and L5-S1 levels.
3. Hypertrophic facetal arthropathy at the L4-L5 level.