sb/bv/nl/nl
Date : 00.00.00

Name of the Patient : Abc Xyza S. lmn / F / 30 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE with paresthesias since 1 month.

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.

SOME IMAGES SHOW PATIENT MOTION AS PATIENT WAS IN SEVERE PAIN.

OBSERVATION :

There is loss of water content of the L4-L5 intervertebral disc with scoliosis of the spine with convexity to the left side.

There is a fairly large, posteriorly extruded disc at the L4-L5 level with thecal sac compression and bilateral neural foraminal narrowing. Inferior migration of the disc is noted in the left lateral recess of L5. There is indentation on the traversing L5 nerve roots bilaterally. The L4-L5 facet joints show slight degenerative changes bilaterally.

A left postero-lateral (foraminal) disc herniation is noted at the L3-L4 level with left neural foraminal narrowing with indentation on the left L3 nerve root.

A small, left far lateral disc bulge is noted at the L2-L3 level.
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The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. The rest of the facet joints and the visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the D12 level and the thecal sac terminates at the L5 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
16.0 mm at L2-L3
16.0 mm at L3-L4
9.0 mm at L4-L5
9.0 mm at L5-S1.

IMPRESSION :

1. A fairly large, posteriorly extruded disc at the L4-L5 level with bilateral neural foraminal narrowing with inferior migration of the disc in the left lateral recess of L5 with indentation on the traversing L5 nerve roots bilaterally.

2. A left postero-lateral (foraminal) disc herniation at the L3-L4 level with indentation on the left L3 nerve root.