Presentation
Low back pain
Patient Data
Last unfused vertebra taken as L5. Loss of normal lumbar lordosis, however the alignment is still preserved. Vertebral bodies and discs are normal in height. Normal marrow signal intensity.
Conus medullaris terminates at L1/L2 level. Filum terminale is thickened with fat intensity seen within (hyperintense on T1 and T2 and suppressed on fat saturated images) measuring 3.5 mm in maximum diameter and approximately 10 cm in length. This lesion shows no enhancement post-gadolinium.
At L5/S1 there is mild disc desiccation with diffuse disc bulge and right posterolateral disc protrusion contacting the traversing right S1 nerve root in the subarticular zone. Mild narrowing of bilateral neural foramina, however the exiting L5 nerve roots are preserved. Mild ligamentum flavum thickening.
Cauda equina are normal. Paraspinal soft tissues are unremarkable.
Case Discussion
Incidental findings of a thickened filum terminale (more than 2mm) with fat intensity within is suggestive of a lipoma of the filum terminale. They may be associated with a low lying or tethered cord, however in this case, the conus is normal in position at L1/L2.
This patient has mild L5/S1 degenerative disc disease contacting the traversing right L5 nerve root, which may be a cause of his low back pain.
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