bv/ke/rg.
Date : 00.00.00

Name of the Patient : Abc Xyzvadan J. lmn / M / 80 yrs.
Referred by : Dr. Abc Xyz. Shah.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE with paresthesias since Novembar 0000.

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 :

All the lumbar intervertebral discs show loss of water content except the L1-L2 disc.

There is evidence of a well-defined lesion measuring approximately 1.2 (L) x 0.9 (B) x 2.0 (H) cms located at the L4-L5 disc and L5 vertebral levels. This lesion is extradural in location with well-defined margins and is seen to compress the thecal sac and displace the sac anteriorly and to the right side. There is also probable impingement of the foraminal L4 nerve root on the left side. This lesion is slightly hyperintense to CSF on the T1 Weighted images and turns nearly isointense to CSF on the T2 Weighted images with a well-defined hypointense peripheral rim.

There is a posterior disc herniation at the L4-L5 level with ventral indentation on the thecal sac and causing bilateral neural foraminal narrowing. Bilateral foraminal and extraforaminal disc bulges are also seen at this level with indentation on the extraforaminal portion of the L4 nerve roots. Mild ligamentum flavum hypertrophy is identified at L4-L5 and L5 levels.
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R> A posterior disc herniation is seen at the L5-S1 level with ventral indentation of the thecal sac. There is facetal arthropathy on the right side at this level with joint effusion and narrowing of the right neural foramen.

There are right postero-lateral disc herniations at the L3-L4 and L2-L3 levels with probable indentation on the right L3 and L2 nerve roots respectively. A left far lateral disc herniation is also seen at the L3-L4 level.

The lumbar vertebral bodies show spotty fatty changes.
The visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the L1 level and the thecal sac terminates at the S1-S2 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
14.0 mm at L2-L3
15.0 mm at L3-L4
11.0 mm at L4-L5
11.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of :

1. An extradural mass lesion measuring approximately 1.2 (L) x 0.9 (B) x 2.0 (H) cms located at the L4-L5 disc and L5 vertebral levels, compressing and displacing the thecal sac anteriorly and to the right side. This is not specific for a single etiology. The possibilities to be considered are,

A. Synovial cyst.

B. A sequestered disc fragment.

3. Posterior disc herniations at the L4-L5 and L5-S1 levels.