Sunday, 27 December 2015 16:48

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Date : 00.00.00

Name of the Patient : Abc Xyzbai Plmn / F / 66 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Dorso-lumbar Spine.

CLINICAL PROFILE :

C/O backache radiating to the LLE since 6 months.

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.

5 mm thick T1 Weighted and T2 Weighted axial images.

OBSERVATION :

There is loss of water content of the visualized dorso-lumbar intervertebral discs.

There is central and slight anterior wedging of the D4, D6, D11, D12, L1, L2 and L3 vertebral bodies.

The L1 vertebral body shows a diffuse hypointense signal on the T1 Weighted images which appears slightly hyperintense on the T2 Weighted images. Some areas continue to remain hypointense on the T2 Weighted images and represents compressed trabeculae. The cortical endplates appear intact. The adjoining intervertebral discs appear unremarkable. Generalized bulge of the L1 vertebral body is noted laterally due to the vertebral body compression.

The rest of the visualized dorso-lumbar vertebral bodies show fatty marrow changes suggesting osteoporosis.

Posterior peridiscal osteophytes are noted at the D10-D11, D11-D12, L1-L2 and L2-L3 levels, minimally indenting the dural theca anteriorly.


Schmorls nodes are identified on the superior surface of D11 and D12 vertebrae.

Posterior and bilateral far lateral disc bulges are seen at the L5-S1 level.

A small postero-central protruded disc is noted at the L4-L5 level.

The facet joints at the L4-L5 and L5-S1 levels appear slightly hypertrophied.

The visualized pre and paravertebral soft tissues are unremarkable.

The visualized dorsal spinal cord reveals normal signal intensity. There is no cord compression.

The conus medullaris terminates at the L1 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 :

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

IMPRESSION :

1. Diffuse fatty marrow changes in the visualized dorso-lumbar vertebral bodies (except the L1 vertebra) suggests osteoporotic changes. Altered signal of the L1 vertebra most likely represents bone bruise.
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2. Central and slight anterior wedging of the D4, D6, D11, D12, L1, L2 and L3 vertebral bodies represent compression fractures superimposed upon an osteoporotic spine.

3. Posterior peridiscal osteophytes at the D10-D11, D11-D12, L1-L2 and L2-L3 levels.

4. Posterior and bilateral far lateral disc bulges at the L5-S1 level.

5. A small postero-central protruded disc at the L4-L5 level.

6. Slight hypertrophy of the facet joints at the L4-L5 and L5-S1 levels.


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