Presentation
Back pain and right sided sciatica.
Patient Data
The conus terminates at L2 in a low position. T1 and T2 hyperintense lesion of the filum extends from the conus at L2 to the S2 level. This lesion completely suppresses on fat suppressing images without contrast enhancement.
T11/T12 to L3/L4: normal.
L4/L5: small right sided disc extrusion results in minimal central canal narrowing but contact of the descending nerve root in the right subarticular recess.
L5/S1: Shallow central disc bulge. Central disc bulge and facet arthropathy but no central canal or neural exit foraminal stenosis.
Conclusion:
Low lying conus (L2) and tethered cord secondary to filum terminale lipoma.
Right L5 nerve root contact from L4/L5 disc extrusion.
Case Discussion
This case demonstrates a typical appearance of an incidental filum terminale lipoma. Whether or not it has any clinical implications in this instance, and whether it contributes to symptoms, is uncertain. Given the patient is 60 year of age, previously asymptomatic, and has a disc extrusion that accounts for symptoms, it is probably entirely asymptomatic.