Name of the Patient : Abc Xyzakala Ralmn / F / 55 yrs.
Referred by : Dr. Abc Xyzrankar.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain radiating to the LLE with paresthesias.
H/O laminectomy with discectomy at L4-L5 in August 0000.

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 Grade I spondylolisthesis of the L4 over the L5 vertebra without obvious spondylolysis.

There is loss of water content of the lumbar intervertebral discs.

There is evidence of laminectomy at the L4 and L5 vertebral levels with post-operative changes in the soft tissues in the posterior lumbar region over these levels.

There is a small posterior disc herniation at the L5-S1 level with facetal hypertrophy at this level.

There is a posteriorly herniated disc at the L4-L5 level with bilateral neural foraminal narrowing. Bilateral far lateral disc herniations are also noted at this level, more on the right side, with indentation on the extraforaminal
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segment of the right L4 nerve root. Hypertrophic facetal arthropathy is noted at this level, more pronounced on the right side, with right lateral recess stenosis.

A small, posterior disc bulge is noted at the L3-L4 level with slight facetal and ligamentum flavum hypertrophy at this level.

The intrathecal nerve roots over the L4 to S1 vertebral levels appear irregular and clumped suggesting arachnoiditis.

There is a conjoint nerve root at the L5 vertebral level, bilaterally.

The lumbar vertebral bodies reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.

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 :

17.0 mm at L1-L2
17.0 mm at L2-L3
11.0 mm at L3-L4

IMPRESSION :

1. Post-operative status.

2. Grade I spondylolisthesis of the L4 over the L5 vertebra without obvious spondylolysis.

3. A small posterior disc herniation at the L5-S1 level with facetal hypertrophy at this level.
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- 3 - Scan-00009

4. A posteriorly herniated disc at the L4-L5 level with bilateral far lateral disc herniations, more on the right side, indenting the extraforaminal segment of the right L4 nerve root. Hypertrophic facetal arthropathy is noted at this level, more pronounced on the right side, with right lateral recess stenosis.

5. A small, posterior disc bulge at the L3-L4 level with slight facetal and ligamentum flavum hypertrophy at this level.

6. Clumped intrathecal nerve roots over the L4 to S1 vertebral levels suggest arachnoiditis.

7. Conjoint nerve root at the L5 vertebral level, bilaterally.

As compared to the previous MRI (dated 00.00.0000 scan no:00006) the patient is now status post-operative. Minimal forward translation of the L4 over the L5 vertebra is noted. The discal disease and facetal hypertrophy is as described above. Clumped intrathecal nerve roots suggest arachnoiditis.