Unknown congenital spinal cord tumor, presenting with severe lumbosacral pain, radiculopathy, inability to ambulate. There is clumping, irregularity, and predominantly posterior displacement of the cauda equina nerve roots at the L5-S1 level, along with what appear to be linear low attenuation bands around the nerve roots. There is a perineural cyst at the S3 level that measures up to approximately 45 mm in width associated with remodeling of the surrounding bone. There are also subcentimeter perineural cysts in the spinal canal at the S2 level. There is mild degenerative spondylosis, including disc bulges and facet hypertrophic changes with trace effusions, in the lower lumbar spine, which result in up to mild bilateral neural foraminal stenosis at L4-5. Otherwise, there is no significant spinal canal stenosis. There are Schmorl nodes at T11-12 level. Otherwise, the vertebral body heights and alignment are intact. There are renal cysts bilaterally. There is a partially-imaged infrarenal aortic aneurysm.
1. Findings suggestive of arachnoiditis and/or arachnoid cyst and adhesion formation versus inclusion cyst at the L5-S1 level, which may be iatrogenic in nature. Otherwise, evaluation for tumor is limited without contrast.2. Sacral perineural cysts, the largest of which measures 45 mm in width at the S3 level.3. No significant lumbar spinal canal stenosis.4. Partially-imaged infrarenal aortic aneurysm. Dedicated vascular imaging may be useful for further characterization.