History of tethered cord. Status post redo untethering, history of 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 immediate postsurgical changes related to recent cord untethering as well as evidence of prior lipomyelomeningocele repair. There are defects involving the posterior elements below the L4 level reflecting combination of laminectomies and dysplasia related to dysraphism. Spinal cord is low lying appearing to terminate near the S1 level where there is a residual lipoma which measures up to 2.6 cm in the craniocaudal dimension and 15 mm in the AP dimension. There is now CSF surrounding the distal cord and lipoma including posteriorly, significantly improved since outside study and indicating untethering. Prone images demonstrate some ventral motion at the level of the lipoma with CSF space dorsal to the lipoma measuring 3.4 mm in the supine position and 4.4 mm in the prone position (measured at the approximately mid S1 level). The spinal cord at the L4-L5 level remains dorsally positioned in both the supine and prone sequences although there is some CSF space separating it from the dura; this is also improved since outside study. There is a small syrinx involving the distal cord, which for example measures approximately 3 mm at the L5 level, with mild prominence of the central canal extending more superiorly to approximately the L3 level. There is mild interval increase in more ill-defined T2 signal surrounding the small syrinx at the L5 level compared to preoperative study.
Immediate postsurgical changes of spinal cord untethering in the setting of a lipomyelomeningocele. Low-lying conus, residual terminal lipoma, and small distal syrinx as above. Distal cord and lipoma appear more anteriorly positioned compared to the preoperative study consistent with untethering. There is slight increase in ill-defined T2 signal surrounding the distal syrinx at the L5 level compared to preoperative study.