sb/hs
Date : 00.00.00

Name of the Patient : Abc Xyzabala Almn / F / 67 yrs.
Referred by : Dr. Abc Xyz. Desai.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O radicular pain in BLE with paresthesias and inability to stand since 1 year.

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 reduction in height and loss of water content of the lumbar intervertebral discs. A hypointense signal on all the pulse sequences in the lumbar intervertebral discs suggests calcium/vacuum phenomena.

There is Grade I spondylolisthesis of the L4 vertebra over the L5 vertebra without obvious spondylolysis. A posterior disc herniation is noted at the L4-L5 level, with bilateral neural foraminal narrowing. There is also hypertrophic facetal arthropathy and ligamentum flavum hypertrophy with resultant canal stenosis. Impingement of the right L4 nerve root in the right neural foramen at the L4-L5 level is also noted. A disc fragment is seen in the anterior epidural space at the L4 vertebral level.

Posterior peridiscal osteophytes with posterior disc herniation is noted at the L5-S1 level, indenting the dural


theca anteriorly. There is mild neural foraminal narrowing bilaterally with indentation upon the exiting left L5 nerve root at this level.

A posterior disc herniation with posterior peridiscal osteophytes is noted at the L3-L4 level with bilateral neural foraminal narrowing. A sequestered disc fragment is noted in the left lateral recess of the L4 vertebra with impingement of the traversing left L4 nerve root.

Posterior disc herniations with peridiscal osteophytes are noted at the D12-L1, L1-L2 and L2-L3 levels, indenting the dural theca anteriorly. A left paracentral disc herniation with a peridiscal osteophyte is noted at the D10-D11 level. A posterior disc bulge is seen at the D11-D12 level.

Slight facetal hypertrophy is noted in the lumbar region.

Ligamentum flavum hypertrophy is also noted at the L3-L4 and L2-L3 levels.

Type II degenerative marrow changes are noted adjacent to the L4-L5 and L5-S1 intervertebral discs.

Anterior disc herniations with anterior peridiscal osteophytes are noted in the lumbar region.

The rest of the lumbar vertebral bodies reveal normal signal intensity. The visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the D12 level and the thecal sac terminates at the S2 level.

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

12.0 mm at L1-L2
..3/.






- 3 - Scan-00009


12.0 mm at L2-L3
13.0 mm at L3-L4
7.0 mm at L4-L5
8.0 mm at L5-S1.

IMPRESSION :

The MRI features are suggestive of :

1. Grade I spondylolisthesis of the L4 vertebra over the L5 vertebra without obvious spondylolysis.

2. A posterior disc herniation at the L4-L5 level, with bilateral neural foraminal narrowing. There is also hypertrophic facetal arthropathy and ligamentum flavum hypertrophy with resultant canal stenosis. Impingement of the right L4 nerve root in the right neural foramen at the L4-L5 level is noted.

3. A posterior disc herniation with posterior peridiscal osteophytes at the L5-S1 level.

4. A posteriorly herniated disc with posterior peridiscal osteophyte at the L3-L4 level with a sequestered disc fragment in the left lateral recess of the L4 vertebra.

5. Posterior disc herniations with posterior peridiscal osteophytes at the D12-L1, L1-L2 and L2-L3 levels with a left paracentral disc herniation with posterior peridiscal osteophytes at the D10-D11 level.

6. Slight facetal hypertrophy in the lumbar region.

7. Ligamentum flavum hypertrophy at the L3-L4 and L2-L3 levels.

8. Lower lumbar canal stenosis.