Clinical question: History of tethered cord repair, x 2 by meningomyelocele, follow up. Signs and symptoms: New symptoms, back pain, and electric shock type pain feeding to lower back. Nonenhanced lumbar MRI:The examination redemonstrates a small lipoma along the dorsal aspect of conus measuring at 19.8 he previous axis and 6.4-mm in AP axis (measured on sagittal series) without interval change since prior study from 2011. Lipoma resolve since subtle flattening and forward displacement of the conus similar to prior exam and without evidence of spinal stenosis. The signal intensity of the cord and conus is otherwise within normal.The lipoma these presented at the level of the superior endplate of L2 and without evidence of any change since prior.Revisualization of stable postoperative changes of prior laminectomy for untethering of the cord and removal of meningomyelocele. There is termination of the cord at upper L2 level which is inseparable from the posterior thecal sac similar to prior exam and suspected for adhesion.Prone sagittal T2 weighted images demonstrate anterior movement of the lower cord however without movement of the tip of the conus which remains inseparable from the posterior wall of the thecal sac and likely representing adhesion. There is apparent worsening of this finding on prone sagittal series by apparent increased point of contact of the lower tip of conus to the posterior wall of thecal sac on sagittal prone T2W series compared to prior prone sagittal T2. This observation can be result of slice positioning and not a true interval change and there are no axial images on prone position for comparison.
1.Revisualization of a stable small lipoma of the dorsal aspect of conus.2.Prone sagittal T2-weighted images demonstrate anterior movement of the lower cord however without movement of the tip of the conus which remains inseparable from the posterior wall of the thecal sac and is suspected on adhesion. Please see above comments.3.Revisualization of postoperative changes of prior cord untethering and removal of the meningomyelocele.