Presentation
Bilateral lower limb weakness and urine incontinence.
Patient Data
The conus is low-lying (terminating at L4) and associated with a posterior neural arch defect (on the right side) at L5. Through this defect, a fatty mass (high T1, T2 signal, low STIR) is attached to the dorsal aspect of the cord and continuous with the adjacent posterior subcutaneous fat. The filum terminale appears separate from the mass and can be traced as it descends anteriorly to the fatty mass in thecal sac. The lipoma-neural placode interface is seen within the spinal canal, in keeping with a tethered cord with spina bifida and lipomyelocele. Small cord syrinx is also noted along L1 and L2 levels.
Case Discussion
Lipomyeloceles are one of the most frequent vertebral malformations that we can see in our usual daily radiological practice. It is a sub-type of occult spinal dysraphism (the defect and the neural placode are covered with the skin).
In which the neural placode-lipoma is located inside the spinal canal. It is also common to see low conus medullaris and tethered cords in these cases.
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