Name of the Patient : Abc Xyzr Bhalmn / M / 55 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.
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.
The cervical and dorsal spines were screened with 5 mm thick T1 Weighted sagittal images.
Areas of hypointensity on the T1 Weighted images which turn hyperintense on the T2 Weighted images are seen to involve the L3 and L4 vertebral bodies and pedicles. There is erosion of the superior cortical endplate of L4 with the L3-L4 intervertebral disc being decreased in height and is hyperintense on the T2 Weighted images suggestive of its involvement. The L2-L3 intervertebral disc is also probably involved.
There is extension of this pathology into the anterior epidural space over the L2-L3 to L4-L5 levels with indentation upon the thecal sac. Also seen is extension into the pre and paravertebral soft tissues over the L2-L3 to L4-L5 levels. The psoas muscles are also involved over these levels with left psoas lesion extending upto atleast the S1 vertebral level. There appears to be encasement of the L3 and L4 nerve roots by the disease process.
There is forward translation of the L5 vertebra over the S1 vertebra.
Anterior disc herniations with peridiscal osteophytes are seen in the lumbar region.
Postero-central disc herniations with peridiscal osteophytes are seen to indent the thecal sac at the L1-L2 and L5-S1 levels. Posterior disc herniations with peridiscal osteophytes are seen to indent the thecal sac and narrow both neural foramina at the L2-L3 and L4-L5 levels.
Bilateral far lateral disc herniations are seen at the L2-L3 and L5-S1 levels and on the right side at the L4-L5 level.
The pedicles of the lower lumbar vertebrae appear congenitally short in their antero-posterior dimensions.
The lumbar facet joints show degenerative changes.
The rest of the visualized dorso-lumbar vertebral bodies show a hypointense signal on the T1 Weighted images (? preponderance of hematopoeitic marrow). The remaining intervertebral discs show loss of water content.
The conus medullaris terminates at the L1 level and the thecal sac terminates at the S2 level.
The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
9.0 mm at L1-L2
8.0 mm at L2-L3
12.0 mm at L3-L4
10.0 mm at L4-L5
7.0 mm at L5-S1.
- 3 - Scan-00007
The MRI features are suggestive of :
1. A pathologic process involving the L3 and L4 vertebrae and the L3-L4 intervertebral disc with soft tissue extensions as described and this most likely represents an infective process like tuberculosis. However, the possibility of this representing a neoplastic process (e.g. a small cell tumor) cannot be entirely excluded.
2. Postero-central disc herniations with peridiscal osteophytes at the L1-L2 and L5-S1 levels.
3. Posterior disc herniations with peridiscal osteophytes at the L2-L3 and L4-L5 levels.
4. Facetal arthropathy with canal stenosis in the lumbar region.