ke/hs/nl/nl
Date : 00.00.00

Name of the Patient : Abc XyzDalmn / M / 87 yrs.
Referred by : Dr. Abc Xyzcha.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache with pain radiating to BLE with paresthesias (left more than right) 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.

OBSERVATION :

There is scoliosis of the lumbar spine with convexity to the right. Left lateral subluxation of the L2 over the L3 vertebra is noted. There is retroplacement of the L2 over the L3 vertebrae.

There is a diffuse posterior disc bulge with peridiscal osteophytes at the L5-S1 level. Severe hypertrophic facetal arthropathy is seen at this level with ligamentum flavum hypertrophy and a resultant tight canal.

Posterior peridiscal osteophytes are seen at the L2-L3, L3-L4 and the L4-L5 levels with bilateral neural foraminal narrowing. Facetal arthropathy is also noted at these levels. There is ligamentum flavum hypertrophy at the L4-L5 level.

Large anterior peridiscal osteophytes are seen in the lower lumbar region.
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Bilateral far lateral (extraforaminal) disc herniations are seen at the L2-L3, L3-L4, L4-L5 and L5-S1 levels and on the right side at the L1-l2 level.

Diffuse fatty changes are seen in the lumbar vertebral bodies. The lumbar intervertebral discs show loss of water content.

The conus medullaris terminates at the L1 level.

The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :

21.0 mm at L1-L2
18.0 mm at L2-L3
17.0 mm at L3-L4
15.0 mm at L4-L5
12.0 mm at L5-S1.

There is replacement of the normal marrow of the visualized sacrum bilaterally by hypointense areas on the T1 Weighted images. These are seen to turn mildly hyperintense on the T2 Weighted images. Similar well-circumscribed areas are also noted in the visualized iliac bones bilaterally.

Well-circumscribed hypointense areas are noted on the T1 Weighted images within the L5 and L1 vertebral bodies. These are seen to turn heterogeneously hyperintense on the T2 Weighted images.

IMPRESSION :

The MRI features are suggestive of :

1. Scoliosis of the lumbar spine with convexity to the right. Left lateral subluxation of the L2 over the L3 vertebra is noted. There is retroplacement of the L2 over the L3 vertebrae.
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2. Diffuse posterior disc bulge with peridiscal osteophytes at the L5-S1 level with severe hypertrophic facetal arthropathy, ligamentum flavum hypertrophy and a resultant tight canal at this level.

3. Posterior peridiscal osteophytes at the L2-L3, L3-L4 and L4-L5 levels with facetal arthropathy at these levels and ligamentum flavum hypertrophy at the L4-L5 level.

4. Large anterior peridiscal osteophytes in the lower lumbar region.

5. Altered signal in the sacrum, and visualized iliac bones and the L5 and L1 vertebral bodies may represent metastasis/small cell tumors.

The possibility of this being an infective process is considered to be unlikely.