Name of the Patient : Abc Xyzed Falmn / M / 55 yrs.
Referred by : Dr. Abc Xyzrankar.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
H/O fall 2 1/2 months back with paraplegia and bladder/bowel involvement since then.
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 appears to be sacralization of the L5 vertebra and it is as marked on the film.
There is scoliosis of the lumbar spine with convexity to the left. Also seen is clockwise rotation of the lumbar vertebrae.
There is slight decrease in the height of the L5 vertebral body with a break of its superior cortical endplate. Slight anterior wedging of the L1 vertebral body is also noted.
A posteriorly herniated disc is seen to indent the thecal sac and narrow both neural foramina at the L4-L5 level. Bilateral far lateral disc bulges are noted at this level.
There is a posteriorly bulging disc and a left far lateral disc herniation at the L3-L4 level.
Left far lateral disc bulges are noted at the D11-D12, D12-L1, L1-L2 and L2-L3 levels.
The lumbar facet joints show mild degenerative changes.
The pedicles of the lumbar vertebrae appear congenitally short in their antero-posterior dimensions.
The lumbar intervertebral discs show loss of water content.
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 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
13.0 mm at D12-L1
12.0 mm at L1-L2
11.0 mm at L2-L3
10.0 mm at L3-L4
8.0 mm at L4-L5
9.0 mm at L5-S1.
The dorsal spine was screened with 4 mm thick T2 Weighted sagittal images and the visualized dorsal spinal cord and conus medullaris show normal signal intensity.
Probable fracture of the sacral ala is noted, bilaterally.
The MRI features are suggestive of :
1. A posteriorly herniated disc with canal stenosis at the L4-L5 level.
2. Congenitally short pedicles of the lumbar vertebrae in their antero-posterior dimensions.
3. A posteriorly bulging disc and a left far lateral disc herniation at the L3-L4 level.
4. Mild facetal arthropathy in the lumbar region.
5. Probable fracture of the sacral ala, bilaterally.