Presentation
Low back pain, no specific presentation as limping, urinary or stool incontinence. No history of previous surgery or other interventional procedures.
Patient Data
This case contains a collection of different components of spinal dysraphism; the first attracting finding is the presence of intrathecal lipoma opposite to L2 down to L5 vertebral bodies seen closely related and separable from the posterior surface of the lower cord which shows abnormal low end opposite level of L3 vertebral body, this is the second component of dysraphism in this case, the lower end of the tethered cord form obtuse angle with the cauda equina seen at the anterior convexity of the aforementioned lipoma, sagittal T2 images confirm the intrathecal location.
The 3rd component is L4 and L5 spina bifida occulta.
The last one is a short course of back subcutaneous dermal sinus opposite to the spina bifida with no dermal or definite muscular extension.
Small hemangiomata in bodies of S3-CX1, no other osseous lesions.
Case Discussion
Spinal dysraphism is a group of anomalies resulting in disorganized spinal column and cord, in our case there are four characteristic findings; cord lipoma seen attached to the lower part of the tethered cord and should be differentiated from the dural lipoma that is seen also a dysraphic feature, the differentiation based on the thecal sac wall as a line of discrimination , in our case the lipoma seen inside the thecal sac while the opposite favors the possibility of dural lipoma, spina bifida and dermal sinus support such diagnosis.
The bony skeleton often shows dysraphic features like butterfly or hemivertebra which are characteristic but not present in our case.
The presence of meningo- or meningomyelocele is a strong evidence but also not present in our case.