sb/hs/rg/nl
Date : 00.00.00
Name of the Patient : Abc Xyz lmn / F / 49 yrs.
Referred by : Dr. Abc Xyzngsarkar.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with pain radiating to BLE with paresthesias since 5 years.
Alleged H/O fall.
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 slight loss of water content of the lumbar intervertebral discs.
Small posterior disc bulges are noted at the L2-L3, L3-L4, L4-L5 and L5-S1 levels. Slight right neural foraminal narrowing is noted at the L2-L3 and L4-L5 levels.
Slight facetal hypertrophy is noted at the L4-L5 and L5-S1 levels.
The lumbar vertebral bodies show spotty fatty marrow changes. The rest of the facet joints and 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 :
16.0 mm at L1-L2
16.0 mm at L2-L3
14.0 mm at L3-L4
11.0 mm at L4-L5
11.0 mm at L5-S1.
IMPRESSION :
1. Small posterior disc bulges at the L2-L3, L3-L4, L4-L5 and L5-S1 levels.
2. Slight facetal hypertrophy at the L4-L5 and L5-S1 levels.