Assessing the Implications of a 6 mm Thecal Sac in a 40-Year-Old
Is having a thecal sac of 6 mm considered excessive for someone who is 40? 1. The normal inward curve of the lumbar spine is straightened, accompanied by some advancement in degenerative disc disease at the L4-L5 region, which impacts both transverse L5 nerve roots, with the right side being more affected than the left. It can be anticipated that symptoms would peak in this area, aligning closely with clinical correlations. **EXAMINATION: MRI OF THE LUMBAR SPINE WITHOUT CONTRAST** **EXAM DATE: June 1, 2025, at 6:30 PM** **CLINICAL HISTORY:** Patients report bilateral lower back pain coupled with weakness in the right leg. **TECHNIQUE:** A series of images was procured, including sagittal T1-weighted, sagittal T2-weighted, and sagittal STIR sequences. Axial T2-weighted scans were captured at the segments from T12 to S1. **CONTRAST:** No contrast dye was administered for this procedure. **COMPARISONS:** Recent lumbar spine X-rays taken on April 29, 2025, and MRI scans dated March 18, 2015. **OBSERVATIONS:** **Bone Structure:** The typical lumbar lordosis curvature appears straightened. Overall, the alignment of the vertebrae is intact, and there are no indications of acute fractures or slips. Noteworthy Modic type II changes are present in the endplates adjacent to the L4-5 intervertebral disc, but no alarming marrow signal changes are apparent. No defects in the pars interarticularis are detected. **T12-L1:** No significant deviations. **L1-2:** No significant deviations. **L2-3:** No significant deviations. **L3-4:** Only mild degenerative changes to the posterior facet are observed. There are no signs of central canal narrowing or foraminal constriction. **L4-5:** As previously mentioned, there is a broad disc protrusion and mild degenerative changes at the posterior facets, slightly more pronounced than earlier assessments. This suggests a flattening of both traversing L5 nerve roots (right more than left) and increased crowding among the remaining nerve roots. The AP diameter of the thecal sac is measured at 6 mm, with mild narrowing observed in the left and right neural foramina. **L5-S1:** Only mild degeneration at the posterior facet is noted. There is neither central canal narrowing nor foraminal stenosis. **Conus medullaris:** The conus terminates at the L1 level and appears unremarkable. **Other Findings:** There are no additional observations.
Answers (1)
7/5/2025, 3:30:52 PM
OpenHealth AI
The assessment of a 6 mm thecal sac, especially given your background of lower back pain and neurological symptoms, warrants careful consideration. The most important aspect to recognize is that thecal sac size can vary, and while 6 mm might not be excessive in every context, its implications depend heavily on accompanying clinical symptoms and other MRI findings.
Explanation
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Thecal Sac and Its Size:
- The thecal sac contains the spinal cord and nerves, providing a protective space for these structures. A typical AP (anterior-posterior) diameter of the thecal sac can vary widely but is usually larger than 6 mm in healthy adults.
- A measurement of 6 mm may indicate some degree of narrowing, particularly in the context of your reported disc degeneration and nerve root involvement.
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Clinical Correlation:
- Your symptoms of lower back pain and right leg weakness align with the MRI findings of nerve root compression due to disc protrusion and possibly inflammation or irritation around the L4-L5 region.
- This suggests that, while thecal sac size can be a factor, the symptoms and functional impact on your life are what require attention.
Next Steps
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Symptom Management: Focus on managing your pain and symptoms:
- Pain Relief: Over-the-counter pain relievers (such as ibuprofen or acetaminophen) can help manage pain. Be sure to follow dosing instructions.
- Heat/Ice Therapy: Apply heat or ice to your lower back to alleviate discomfort (15-20 minutes at a time).
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Physical Activity:
- Engage in gentle stretching and strengthening exercises to improve flexibility and support your spine. Be cautious, and listen to your body to avoid exacerbating symptoms.
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Monitoring Symptoms:
- Keep track of your symptoms, including any changes in pain intensity, mobility, or neurological symptoms like numbness or weakness. This information can be helpful in any future discussions regarding your care.
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Considerations for Further Evaluation:
- Depending on how your symptoms evolve, consider whether you might benefit from physical therapy or further evaluation by a specialist such as a spine-focused physiotherapist or a neurologist.
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Lifestyle Modifications:
- Maintain a healthy weight, incorporate low-impact exercises (e.g., swimming or walking), and ensure proper ergonomics at work and home to reduce strain on your back.
It's understandable to feel concerned given these findings, but many people manage their symptoms effectively through lifestyle adjustments and appropriate care.Continue monitoring your situation, and do not hesitate to revisit any concerns or worsening symptoms with a healthcare professional.
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