sb/ke/nl/rg.
Date : 00.00.00

Name of the Patient : Abc Xyz Manslmn / F / 65 yrs.
Referred by : Dr. Abc Xyzcha.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

C/O backache radiating to BLE with paresthesias since 3-4 years.
H/O fall 15-20 days back with weakness of BLE (left more than right).
H/O cervical lymphadenopathy since 6 months. On AKT since then.
H/O Pulmonary kochs 25 years ago. Received AKT.

EXAMINATION :

M.R.I of the dorso-lumbar spine was performed using the following parameters :

5 mm thick T1 Weighted and T2 Weighted sagittal images.

7 mm thick T1 Weighted and T2 Weighted axial images.

The lumbar spine was screened with 5 mm thick T1 Weighted sagittal images and 5 mm thick T2 Weighted axial images.

SOME IMAGES SHOW MOTION ARTIFACTS.

OBSERVATION :

The D9 and D10 vertebral bodies show an ill-defined, hypointense signal on the T1 Weighted images which remains hypointense on the T2 Weighted images. Slight irregularity of the cortical endplates adjacent to the D9-D10 intervertebral disc is noted. A posterior peridiscal osteophyte is noted at the D9-D10 level, indenting the dorsal spinal cord at that level. There is also facetal hypertrophy and resultant canal stenosis at this level. The D9 nerve roots are impinged in the neural foramen at the D9-D10 level bilaterally. The dorsal spinal cord at this level shows a hyperintense signal on the T2 Weighted images which suggest cord edema/contusion/ischemia.


Minimal left paravertebral soft tissue lesion is noted at the D9-D10 and D10-D11 levels which is hypointense on all the pulse sequences.

The rest of the visualized dorso-lumbar vertebral bodies show spotty fatty marrow changes which suggest osteoporotic changes. The D11 vertebral body is reduced in height. The visualized dorso-lumbar intervertebral discs show loss of water content. The facet joints and the visualized prevertebral soft tissues are unremarkable.

The conus medullaris terminates at the L1 level.

Screening images of the lumbo-sacral spine reveal reduction in height of the L5-S1 disc. There is Grade II spondylolisthesis of the L5 over the S1 vertebra with spondylolysis at L5, bilaterally. Resultant pseudoposterior disc herniation is noted at the L5-S1 level with bilateral neural foraminal narrowing.

Posterior disc bulges are noted at the rest of the lumbar disc levels with slight bilateral neural foraminal narrowing. Mild facetal hypertrophy is also noted in the lumbar region. The lumbar vertebral bodies also show spotty fatty marrow changes.

A focal hypointense signal on the T1 Weighted images is noted in the ala of the sacrum on the left.

IMPRESSION :

1. Osteoporotic changes in the visualized dorsal and lumbar vertebrae.
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2. Altered signal of the D9 and D10 vertebral bodies as described is not specific for a single etiology. This changes may represent osteoporotic fractures (recent h/o fall) or may represent long standing infective lesion (sclerotic changes, past h/o pulmonary kochs, tuberculous cervical lymphadinitis). The possibility of a neoplasm although less likely, cannot be entirely excluded.

3. Posterior peridiscal osteophyte at the D9-D10 level with facetal hypertrophy and resultant canal stenosis. Altered cord signal at this level suggest cord edema/contusion/ischemia.

4. Grade II spondylolisthesis of the L5 over the S1 vertebra with spondylolysis at L5, bilaterally, with a pseudoposterior disc herniation at the L5-S1 level.

5. Posterior disc bulges and facetal hypertrophy in the lumbar region as described.