ke/sb/rg/nl
Date : 00.00.00
Name of the Patient : Abc XyzJalmn / M / 47 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Lumbo-sacral Spine.
CLINICAL PROFILE :
C/O backache with tingling in the RLE since 2 years.
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 forward translation of the L5 vertebra over the S1
vertebra with probable spondylolysis at L5.
There is a postero-central disc herniation at the L5-S1 level with anterior indentation of the thecal sac.
Small postero-central disc herniations are noted at the L2-L3 and L4-L5 levels with anterior indentation of the thecal sac. The L2-L3, L4-L5 and L5-S1 intervertebral discs show loss of water content.
The lumbar vertebral bodies and the remaining intervertebral discs reveal normal signal intensity. 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 S1 level.
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The antero-posterior dimensions of the lumbar canal at the level of the intervertebral discs are as follows :
17.0 mm at L1-L2
15.0 mm at L2-L3
17.0 mm at L3-L4
13.0 mm at L4-L5
14.0 mm at L5-S1.
IMPRESSION :
The MRI features are suggestive of :
1. Forward translation of the L5 vertebra over the S1
vertebra with probable spondylolysis at L5.
2. A postero-central disc herniation at the L5-S1 level.
3. Small postero-central disc herniations at the L2-L3 and L4-L5 levels.