MRI of the Sacrum and Coccyx

Radiology Report  
  
Patient Name: John Doe  
Patient ID: 123456  
Date of Examination: October 15, 2023  
Referring Physician: Dr. Smith  
Examination: MRI of the Lumbar Spine  
  
Clinical Indication:  
The patient presents with chronic lower back pain radiating to the left leg, with a history of lumbar disc herniation. The examination is requested to evaluate for any disc pathology or nerve root compression.  
  
Technique:  
MRI of the lumbar spine was performed using standard protocol sequences, including T1-weighted, T2-weighted, and STIR images in sagittal and axial planes.  
  
Findings:  
- Alignment: Normal lumbar lordosis is maintained. No evidence of spondylolisthesis.  
- Vertebrae: Vertebral body heights are preserved. No acute fractures or marrow signal abnormalities are noted.  
- Discs:  
  - L1-L2, L2-L3, L3-L4: No significant disc bulge or herniation.  
  - L4-L5: Mild disc bulge with slight effacement of the thecal sac. No significant foraminal narrowing.  
  - L5-S1: Moderate disc herniation with impingement on the left S1 nerve root.  
- Spinal Canal and Neural Foramina: The spinal canal is of normal caliber. Mild narrowing of the left neural foramen at L5-S1 due to disc herniation.  
- Other Findings: No evidence of spinal cord compression or abnormal intradural signal.  
  
Impression:  
1. Moderate disc herniation at L5-S1 with impingement on the left S1 nerve root, correlating with the patient's symptoms of left leg radiculopathy.  
2. Mild disc bulge at L4-L5 without significant neural compromise.  
  
Recommendations:  
Clinical correlation is advised. Consideration for neurosurgical consultation if symptoms persist or worsen. Physical therapy and pain management may be beneficial. Follow-up imaging may be warranted based on clinical progression.  
  
Radiologist: Dr. Emily Carter  
Date of Report: October 16, 2023