Name of the Patient : Abc XyzKlmn / M / 72 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain radiating to BLE with paresthesias.

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 loss of normal lumbar lordosis and loss of water content of the L2-L3, L3-L4, L4-L5 and L5-S1 intervertebral discs.

There is scoliosis of the lumbar spine with convexity to the left and slight clockwise rotation of the upper lumbar vertebrae.

A posterior disc herniation with peridiscal osteophytes is seen at the L4-L5 level with anterior indentation of the thecal sac and bilateral neural foraminal narrowing. There is slight inferior migration of the disc. Minimal indentation on the traversing L5 nerve roots is noted. Mild facetal hypertrophy at the L5-S1 level with ligamentum flavum hypertrophy is also seen at this level with resultant canal stenosis.


A postero-central disc herniation with peridiscal osteophytes is noted at the L3-L4 level with anterior indentation of the thecal sac and mild bilateral neural foraminal narrowing. Slight superior migration of the disc is noted. Hypertrophic facetal arthropathy and ligamentum flavum hypertrophy is also noted at this level with central and lateral canal stenosis.

A small posterior disc herniation with peridiscal osteophytes is seen at the L5-S1 level with mild indentation on the traversing S1 nerve roots.

Mild posterior disc bulges are seen at the L1-L2 and L2-L3 levels.

Right far lateral disc herniations and left far lateral disc bulges are seen at the L3-L4 and L4-L5 levels.

Bilateral far lateral disc bulges are seen at the L1-L2, L2-L3 and L5-S1 levels.

The rest of the lumbar facets are hypertrophied. Mild ligamentum flavum hypertrophy is also noted at the L2-L3 and L5-S1 levels.

Anterior disc herniations are seen at the L3-L4 and L4-L5 levels.

The pedicles of the lower lumbar vertebrae are congenitally short in their antero-posterior dimensions.

There is excess of epidural fat at the L5-S1 and S1 level with trifoliate deformity which may suggest epidural lipomatosis.

The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.
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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 :

16.0 mm at L1-L2
12.0 mm at L2-L3
8.0 mm at L3-L4
9.0 mm at L4-L5
10.0 mm at L5-S1.

Cortical renal cyst is noted on the right side.

IMPRESSION :

The MRI features are suggestive of :

1. A posterior disc herniation with peridiscal osteophytes at the L4-L5 level, minimally indenting the traversing L5 nerve roots.

2. A postero-central disc herniation with peridiscal osteophytes at the L3-L4 level with slight superior migration of the disc.

3. A small posterior disc herniation with peridiscal osteophytes at the L5-S1 level with mild indentation on the traversing S1 nerve roots.

4. Hypertrophied lumbar facets and mild ligamentum flavum hypertrophy at the L2-L3 and L5-S1 levels.

5. Congenitally short pedicles of the lower lumbar vertebrae in their antero-posterior dimensions.

6. Canal stenosis at the L4-L5 and L3-L4 levels.