Name of the Patient : Abc Xyz Jlmn / F / 35 yrs.
Referred by : Dr. Abc Xyzshi.
Examination : M.R.I. of the Dorso-lumbar Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to BLE since 6-7 months.
H/O Miliary Tuberculosis. Received AKT for 6 months.
M.R.I of the dorso-lumbar 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 collapse of the D12 vertebral body with a kyphus at that level. The D11, D12 and L1 vertebral bodies appear hypointense on the T1 Weighted images and hyperintense on the T2 Weighted images. The endplates adjacent to the D11-D12 and D12-L1 intervertebral discs appear ill-defined with involvement of the corresponding intervertebral discs. The pedicles of D12 and L1 vertebrae are also involved.
There is seen an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the prevertebral, paravertebral and anterior epidural space over D11 to L1 vertebral levels and in the right paravertebral region upto the L2 vertebral level. This lesion appears hyperintense on the T2 Weighted images. There is encasement of the exiting D12 and L1 nerve roots in the corresponding neural foramen, bilaterally. There is also mild indentation on tip of the conus medullaris which shows a subtle hyperintense signal on the T2 Weighted images.
The rest of the visualized dorso-lumbar vertebral bodies reveal normal signal intensity. The intervertebral discs at the L4-L5 and L5-S1 levels show loss of water content.
Suspicious spondylolysis is noted at the L5 vertebral level bilaterally, with a small pseudo-posterior disc bulge at that level. Minimal forward translation of the L5 over the S1 vertebra is noted. A small postero-central protruded disc is noted at the L4-L5 level.
The conus medullaris terminates at the L1 level.
Screening T1 Weighted sagittal images of the cervico-dorsal region do not reveal any significant feature of note.
1. Collapse of the D12 vertebral body with altered signal of the D11, D12 and L1 vertebral bodies and involvement of the D11-D12 and D12-L1 intervertebral discs suggests osteitis with discitis, most likely of tuberculous etiology. Prevertebral, paravertebral and anterior epidural soft tissue lesion would represent granulation tissue/abscess. There is resultant mild compression of the tip of the conus medullaris with subtle altered signal, suggesting cord edema/ischemia.
2. Suspicious spondylolysis at the L5 vertebral level bilaterally, with minimal forward translation of the L5 over the S1 vertebra and a small pseudo-posterior disc bulge at the L5-S1 level.