Name of the Patient : Abc Xyza Paralmn / F / 37 yrs.
Referred by : Dr. Abc Xyzodak.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the LLE with paresthesias.
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 is a small posterior disc herniation with peridiscal osteophytes and bilateral far lateral disc bulges at the L4-L5 level with anterior indentation of the thecal sac and bilateral neural foraminal narrowing. The L4-L5 facet joints show hypertrophic degenerative changes, left more than right. Minimal fluid is noted in the left facet joint at this level.
There is seen an approximately 9.0 mm diameter sized lesion in the left postero-lateral epidural space at the L4-L5 level which is slightly hyperintense to CSF on all pulse sequences (scans 103.3, 106.6). There is resultant indentation of the thecal sac. This lesion most likely represents a synovial cyst, rather than a sequestered disc fragment.
There is a small, posterior disc bulge at the L5-S1 level. The L5-S1 facet joint on the left shows mild degenerative change. The L4-L5 and L5-S1 intervertebral discs show loss of water content.
The upper lumbar facet joints also show mild degenerative changes.
Type II degenerative changes are noted in the L5 and S1 vertebral bodies adjacent to the L5-S1 disc.
The rest of 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 :
17.0 mm at L1-L2
18.0 mm at L2-L3
16.0 mm at L3-L4
10.0 mm at L4-L5
12.0 mm at L5-S1.
The sacro-iliac joint were further studied with the help of 4 mm thick T1 Weighted and STIR coronal images and 5 mm thick T1 Weighted and T2 Weighted (with fat saturation) axial images which shows hypointense areas in the iliac bones bilaterally on all the pulse sequences adjacent to the sacro-iliac joints, suggestive of sclerosis (osteitis condensans ilii) .
1. A small posterior disc herniation with peridiscal osteophytes and bilateral far lateral disc bulges at the L4-L5 level with hypertrophic facetal arthropathy at the L4-L5 level, left more than right with minimal fluid in the left facet joint at this level.
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2. A 9.0 mm diameter sized lesion in the left postero-lateral epidural space at the L4-L5 level may represent a synovial cyst rather than a sequesterd disc fragment.
3. A small, posterior disc bulge at the L5-S1 level with facetal arthropathy on the left at this level.
4. Facetal arthropathy of the upper lumbar facet joints.
4. Altered signal in the iliac bone bilaterally on all the pulse sequences adjacent to the sacro-iliac joints, suggestive of sclerosis (osteitis condensans ilii).