ke/hs/rg/nl
Name of the Patient : Abc Xyz H. lmn / M / 76 yrs.
Referred by : Dr. Abc XyzShanbag.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to the LLE since 2-3 months.
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 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 right.
There is slight forward translation of the L5 vertebra over the S1 vertebra and mild retroplacement of the L3 over the L4 and L4 over the L5 vertebrae.
A posterior disc herniation with peridiscal osteophytes is seen at the L4-L5 level with anterior compression of the thecal sac and bilateral neural foraminal narrowing. Ligamentum flavum hypertrophy and hypertrophic facetal arthropathy is also noted at this level with resultant canal stenosis.
A posterior and left far lateral disc herniation is seen at the L3-L4 level with anterior indentation of the thecal sac and indentation upon the foraminal and extraforaminal portion of the exiting left L3 nerve root.
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- 2 - Scan-00005
The rest of the lumbar facet joints also show degenerative changes.
A left far lateral disc herniation is seen to indent the extraforaminal portion of the exiting left L2 nerve root at the L2-L3 level.
Far lateral disc bulges are seen bilaterally at the L4-L5 and L5-S1 levels and on the right side at the L3-L4 and L2-L3 levels.
Small posterior disc bulges with peridiscal osteophytes are seen at the L1-L2, L2-L3 and L5-S1 levels. Anterior disc herniations with peridiscal osteophytes are seen in the lumbar region. The lumbar intervertebral discs show loss of water content.
The lumbar vertebral bodies reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.
The conus medullaris terminates at the L1-L2 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 :
14.0 mm at L1-L2
15.0 mm at L2-L3
12.0 mm at L3-L4
11.0 mm at L4-L5
14.0 mm at L5-S1.
IMPRESSION :
The MRI features are suggestive of :
1. Sacralization of the L5 vertebra.
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- 3 - Scan-00005
2. Scoliosis of the lumbar spine with convexity to the right and slight forward translation of the L5 over the S1 vertebrae and mild retroplacement of the L3 over the L4 and L4 over the L5 vertebrae.
3. A posterior disc herniation with peridiscal osteophytes at the L4-L5 level with ligamentum flavum hypertrophy and hypertrophic facetal arthropathy with resultant canal stenosis at this level .
4. A posterior and left far lateral disc herniation at the L3-L4 level with indentation upon the foraminal and extraforaminal portion of the exiting left L3 nerve root.
5. A left far lateral disc herniation indenting the extraforaminal portion of the exiting left L2 nerve root at the L2-L3 level.