sb/ke/rg/nl
Name of the Patient : Abc XyzR. Melmn / F / 25 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 LLE with tingling.
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 loss of water content of the L5-S1 intervertebral disc.
There is a fairly large, postero-central and left paracentral extruded disc with peridiscal osteophytes at the L5-S1 level with inferior migration of the disc fragment indenting the thecal sac and the traversing left S1 nerve root which is probably inflamed. A probable sequestered disc fragment is noted in the left lateral recess of S1. Slight facetal hypertrophy is noted at this level.
A minimal posterior disc bulge with peridiscal osteophytes is noted at the L4-L5 level with slight facetal hypertrophy at this level.
Schmorls nodes are seen in the lumbar region.
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.
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The conus medullaris terminates at the D12 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 :
18.0 mm at L1-L2
17.0 mm at L2-L3
16.0 mm at L3-L4
12.0 mm at L4-L5
11.0 mm at L5-S1.
IMPRESSION :
1. A fairly large, postero-central and left paracentral extruded disc with peridiscal osteophytes at the L5-S1 level with inferior migration of the disc fragment indenting the traversing left S1 nerve root which is probably inflamed. A probable sequestered disc fragment is noted in the left lateral recess of S1.
2. A minimal posterior disc bulge with peridiscal osteophytes at the L4-L5 level.
3. Slight facetal hypertrophy at the L4-L5 and L5-S1 levels.