Back pain, history of tethered cord repair. Prior lipomyelomeningocele. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. Alignment is within normal limits. Bone marrow signal is benign. There are postsurgical changes in the lower lumbar spine related to lipomyelomeningocele repair and tethered cord release. Deficiency involving the posterior elements likely reflects combination of surgical change and dysplasia. Conus is low lying terminating at the mid to lower L4 level. There is an intradural lipoma along the posterior aspect of the distal cord measuring up to 11 x 13 in the axial plane and approximately 5.4 cm in the craniocaudal dimension. No other masses within the lumbar spinal canal. There is no evidence of syrinx or other signal abnormality within the cord. There are degenerative changes primarily consisting of moderate facet arthropathy in the lower lumbar spine at the L4-L5 and L5-S1 levels, particularly on the right with small adjacent synovial cysts. There are minimal disc bulges as well as a tiny central protrusion at the L4-L5 level. There is no significant spinal canal stenosis at any level. There is minimal narrowing of the bilateral L4-L5 neural foramina. Neural foramina are otherwise patent.
Postsurgical changes related to prior lipomyelomeningocele repair and tethered cord release. Conus terminates at the inferior L4 level and is associated with an intradural lipoma in its posterior aspect. There is absence of ventral motion of the conus on the prone sequences which can be seen with re-tethering in the appropriate clinical setting.