ke/hs/nl/rg.
Name of the Patient : Abc Xyzabhaga Jalmn / F / 55 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with weakness of BLE.
Past H/O spinal surgery. (Details not available).
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 and it is as marked on the film. Please correlate with plain radiographs.
There are post-operative changes with suscepitibility artifacts over the L2 to L5 vertebral levels (laminectomy of the L2 and L3 vertebrae on the radiographs).
Slight forward translation of the L3 vertebra over the L4 vertebra is seen with a small posterior disc herniation at this level.
There is a large posterior disc extrusion at the L2-L3 level with anterior compression of the thecal sac. Superior migration of the disc is seen posterior to the L2 vertebral body with compression upon the thecal sac. There is a posteriorly bulging disc at the L4-L5 level.
The L2-L3, L3-L4 and L4-L5 facet joints show hypertrophic degenerative changes. The L1-L2 facet joints show mild degenerative changes.
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The L2-L3, L3-L4 and L4-L5 intervertebral discs show loss of water content.
The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. 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 :
14.0 mm at L1-L2
12.0 mm at L2-L3
16.0 mm at L3-L4
16.0 mm at L4-L5
12.0 mm at L5-S1.
IMPRESSION :
1. Post-operative status.
2. Sacralization of the L5 vertebra.
3. Slight forward translation of the L3 vertebra over the L4 vertebra with a small posterior disc herniation at this level.
4. A large posterior disc extrusion at the L2-L3 level with superior migration of the disc lying posterior to the L2 vertebral body.
5. Hypertrophic facetal arthropathy at the L2-L3, L3-L4 and L4-L5 levels and mild facetal arthropathy at the L1-L2 level.