ke/sb
Date : 00.00.00

Name of the Patient : Abc Xyzla B. Shlmn / M / 52 yrs.
Referred by : Dr. Abc Xyzrekh.
Examination : M.R.I. of the Lumbo-sacral Spine.

CLINICAL PROFILE :

C/O backache radiating to the RLE with paresthesias 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 mild retroplacement of the L4 over the L5 vertebra.

A pseudo-posterior disc herniation with peridiscal osteophyte is seen at the L4-L5 level with anterior indentation of the thecal sac and right neural foraminal narrowing. The L4-L5 facet joint on the right side shows degenerative changes. Slight inferior migration of the disc fragment is noted.

A small postero-central disc herniation is seen at the L3-L4 level.

A left far lateral disc bulge is seen at the L5-S1 level. The L5-S1 facet joint on the left side shows hypertrophic degenerative change with indentation upon the left S1 nerve root.

Schmorls nodes are noted in the dorso-lumbar region.

The dorso-lumbar intervertebral discs show slight loss of water content.
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The lumbar vertebral bodies reveal normal signal intensity. The rest of the facet joints and the visualized pre and paravertebral soft tissues are unremarkable.

The conus medullaris terminates at the D12-L1 level and the thecal sac terminates at the S1 level.

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

16.0 mm at L1-L2
15.0 mm at L2-L3
14.0 mm at L3-L4
14.0 mm at L4-L5
13.0 mm at L5-S1.

IMPRESSION :

1. Mild retroplacement of the L4 over the L5 vertebra.

2. A pseudo-posterior disc herniation with peridiscal osteophyte at the L4-L5 level with facetal arthropathy on the right side and a tight canal.

3. A small postero-central disc herniation at the L3-L4 level.

4. A left far lateral disc bulge at the L5-S1 level with hypertrophic facetal arthropathy on the left side.