MRI OF LUMBO-SACRAL SPINE WITH WHOLE SPINE SCREENING:

MR imaging of the lumbosacral spine was performed and high resolution T1- and T2- weighted serial sections obtained
in the sagittal and axial planes using a Phased-Array surface coil on a 1.5 Tesla scanner with high strength gradients.

There is evidence of abnormal signal intensity lesion noted involving right lateral aspect of
L2 and L3 vertebral bodies and intervening intervertebral disc.
It demonstrates hypointense signal on T1W images and heterogeneously hyperintense
signal on T2W images & fat suppressed images. There is minimal surrounding marrow
edema involving the involved vertebral bodies.
There is subligamentous extension of the above mentioned signal intensity to bilateral
paravertebral region causing collections in bilateral psoas muscles.
Right psoas collection measures approx 69 x 22 mm.
Left psoas collection measures approx 37 x 10 mm.
There is epidural extension of the signal intensity to form an epidural collection in right
lateral epidural region which extends from L2-L4 levels causing spinal canal stenosis,
compression over right traversing and exiting nerve roots.
Degenerative schmorl’s nodes are noted involving superior endplates of L2 and L3.

L2-L3 and L3-4 levels: Diffuse posterior as well as foraminal disc herniations are noted
which along with the epidural collections cause spinal canal stenosis and compression
over bilateral exiting and traversing nerve roots, more on right side.
L5-S1 level: Diffuse posterior disc buldge is noted without significant compression over
nerve roots.

L4-L5 level: Diffuse posterior disc buldge is noted causing impingement over bilateral
exiting nerve roots.

MR myelography shows complete extradural block at L2-3-4 levels.

The lower end of spinal cord and conus medullaris are normal.
Ligamentum flavum & facet joints do not reveal any abnormality.

AP spinal canal diameters:

L1-L2 L2-L3 L3-L4 L4-L5 L5-S1
mm mm mm mm mm

Whole spine screening:

 Diffuse spondylotic changes are noted involving cervical spine with marginal
osteophytes formation and endplates sclerosis.
 Diffuse hypertrophied posterior longitudinal ligament is noted with possible
ossification(OPLL).
 An epidural collection is noted involving posterior epidural region on left side
from C3 to C7 level causing spinal canal narrowing and compression over
corresponding cervical nerve roots and spinal cord, however no cord edema.
 There is also posterior element marrow edema involving left side at same level
along with posterior neck muscle edema.
 C3-4, C4-5: Diffuse disc osteophytes complex is noted along with left posterior
epidural collection causing left sided nerve roots compression.
  C5-6, C6-7: Diffuse disc osteophytes complex along with bilateral facetal joint
hypertrophy and left posterior epidural collection causing both sided nerve
roots compression, more on left side.

Multiple level schmorl’s nodes are noted involving dorsal region.

IMPRESSION:
 Abnormal signal intensity lesion involving right lateral aspect of L2 and L3
vertebral bodies and intervening intervertebral disc with subligamentous
extension to epidural and bilateral psoas region as above causing marked
nerural compression at L2, L3, L4 levels as above.
 Abnormal posterior epidural collection involving cervical region with extensive
disc changes causing significant cord and nerve roots compression at C3-C7
levels.
Findings are of multilevel infective spondylo-discitis possibility of Koch’ s etiology
likely.

DR. RAJENDRA SOLANKI DR. RASHMIN GAJJAR DR. RUCHIT PATEL DR. NIKUNJ BANKER DR. BRIJESH GAJJAR DR. YASHPAL RANA
M.D. M.D. M.D. M.D. M.D. M.D.