sb/bv/nl/nl
Name of the Patient : Abc Xyz H. Milmn / M / 43 yrs.
Referred by : Dr. Abc Xyzpta.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to BLE, weakness and 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 sacralization of the L5 vertebra.
There is loss of water content of the lumbar intervertebral discs.
There is mild scoliosis of the lumbar spine with convexity to the left.
There is a postero-central disc herniation with peridiscal osteophyte at the L4-L5 level with indentation on the traversing right L5 nerve root. Postero-lateral (foraminal) disc bulges are seen at this level with indentation upon the
foraminal L4 nerve roots.
There is a left postero-lateral (foraminal) disc herniation with peridiscal osteophytes at the L3-L4 level with indentation on the traversing left L4 nerve root.
A fairly large, posteriorly extruded disc with peridiscal osteophytes is noted at the L2-L3 level with thecal sac compression. Inferior migration of the disc fragment is noted, more to the left of the midline, with indentation on the traversing L3 nerve roots bilaterally.
A postero-central disc herniation with peridiscal osteophytes is noted at the L1-L2 level.
Slight facetal hypertrophy is noted at the L4-L5 and L5-S1 levels.
Schmorls nodes are noted in the dorso-lumbar region.
Anterior disc herniations with peridiscal osteophytes are seen in the lumbar region.
The lumbar vertebral bodies show spotty fatty marrow changes. The visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the D12-L1 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 :
13.0 mm at L1-L2
12.0 mm at L2-L3
13.0 mm at L3-L4
11.0 mm at L4-L5
10.0 mm at L5-S1.
IMPRESSION :
1. Sacralization of the L5 vertebra.
2. A postero-central disc herniation with peridiscal osteophyte at the L4-L5 level with indentation on the traversing right L5 nerve root.
..3/.
- 3 - Scan-00003
3. A left postero-lateral (foraminal) disc herniation with peridiscal osteophytes at the L3-L4 level with indentation on the traversing left L4 nerve root.
4. A fairly large, posteriorly extruded disc with peridiscal osteophytes at the L2-L3 level with inferior migration of the disc fragment, more to the left of the midline, indenting the traversing L3 nerve roots bilaterally.
5. A postero-central disc herniation with peridiscal osteophytes at the L1-L2 level.
6. Slight facetal hypertrophy at the L4-L5 and L5-S1 levels.