A systematic review of alignment, marrow, discs, canal, foramina, conus, and paraspinal tissues on lumbar MRI, with a normal report example.
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A normal lumbar MRI report should communicate more than “no disc herniation.” Vertebral alignment, marrow signal, discs, facet joints, spinal canal, lateral recesses, neural foramina, conus medullaris, cauda equina, and paraspinal soft tissues should be reviewed systematically.
Lumbar MRI findings change with age. Mild disc desiccation, small broad-based bulges, or facet degeneration may be seen in asymptomatic individuals. “Normal” should therefore be distinguished from “mild age-related degenerative change,” and imaging findings should not automatically be presented as the cause of symptoms.
Clinical safety note: A template does not replace level-by-level review. Do not use a routine normal template when infection, tumor, fracture, or cauda equina compression is a clinical concern.
Consider vertebral count, lumbosacral transitional anatomy, and the lowest rib-bearing vertebra. If full-spine imaging is unavailable, absolute level numbering may be limited. Review lordosis, scoliosis, listhesis, and overall alignment.
Assess body heights, endplates, focal marrow lesions, and fracture-related signal. Fatty marrow conversion and common benign lesions such as hemangiomas may mean the study is not strictly normal.
Evaluate disc height and signal at every level. Describe bulge, protrusion, extrusion, or annular fissure using consistent nomenclature. A disc with clear desiccation is not entirely normal.
Assess the central canal, thecal sac, lateral recesses, and cauda equina roots. When narrowing is present, state the level and severity.
Evaluate the right and left foramina separately at every level. Preservation of foraminal fat and the relationship to the exiting nerve root are important.
Review for facet arthropathy, effusion, hypertrophy, and ligamentum flavum thickening. Mild degenerative change should not be overemphasized without clinical relevance.
Assess conus level, signal, and morphology. Termination level varies anatomically and should be interpreted with confidence in vertebral numbering. Look for clumping or compression of the cauda equina roots.
Review the paraspinal muscles, visible retroperitoneal structures, and partially imaged sacroiliac joints for significant abnormalities. Partially visualized organs should not be declared completely normal.
Technique: Multiplanar, multisequence MRI of the lumbar spine was performed without intravenous contrast.
Comparison: None available.
Findings: Lumbar lordosis and vertebral alignment are preserved. Vertebral body heights and marrow signal are within normal limits. Intervertebral disc heights and signal are preserved. No disc herniation, spinal canal stenosis, lateral recess narrowing, or neural foraminal stenosis is identified at the evaluated levels. The facet joints and posterior elements are unremarkable. The conus medullaris terminates at a normal level and demonstrates normal signal. No abnormality of the cauda equina roots is identified. No significant abnormality is present in the paraspinal soft tissues.
Impression: Lumbar spine MRI within normal limits.The phrase “terminates at a normal level” should only be used when vertebral numbering is reliable. The actual level may be stated when appropriate.
T12-L1: Normal disc contour. The spinal canal and neural foramina are patent. L1-2: Normal disc contour. The spinal canal and neural foramina are patent. L2-3: Normal disc contour. The spinal canal and neural foramina are patent. L3-4: Normal disc contour. The spinal canal and neural foramina are patent. L4-5: Normal disc contour. The spinal canal and neural foramina are patent. L5-S1: Normal disc contour. The spinal canal and neural foramina are patent.A level-by-level structure may reduce omission errors, although excessive repetition may reduce readability. Choose the format that best fits local practice.
Disc desiccation, height loss, bulging, or facet degeneration means the study is not completely normal. Describe the finding accurately without implying that it definitely explains the patient’s symptoms.
Example:
Mild disc desiccation and minimal broad-based bulging are present at L4-5. No significant spinal canal or neural foraminal stenosis.This is better described as mild degenerative change without significant neural compression.
Postoperative change, infection, tumor, inflammatory disease, and suspected intradural pathology may require contrast-enhanced imaging. A routine noncontrast normal lumbar MRI template is not sufficient for those indications.
Lumbosacral transitional anatomy may lead to wrong-level reporting. State the numbering method when uncertain.
Lateral recesses and neural foramina cannot be assessed reliably without axial review.
Disc terminology should be consistent, with clear description of morphology and neural impact.
Overfocusing on the discs may lead to missed intradural or conus abnormalities.
Imaging findings and pain should not be presented as automatically causal.
Not strictly. The finding should be described, with clarification that there is no significant canal or nerve-root compromise when appropriate.
No. This depends on local reporting style, but every level must still be reviewed.
Not necessarily, but the conus should always be assessed. If abnormal or uncertain, its level and appearance should be described.
Legal and clinical note: This article is educational and does not replace patient-specific interpretation, current nomenclature, local protocols, or specialist judgment.
This content is educational and is not patient-specific medical advice. Every phrase, template, classification result, and recommendation must be verified and adapted by a physician using the complete examination, clinical context, current guidelines, and institutional protocol.
Open a normal report framework in RadPhrases, then verify and adapt every line to the images and clinical question.