44-year-old female patient with myelomeningocele at birth status post tethered cord repair. Three month follow-up examination following surgery. Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is a lumbar dextroscoliosis with the apex at L4/L5. Bone marrow signal is benign. The conus medullaris is low lying and terminates at the level of L2/L3. There are post-surgical changes of a laminectomy of L4 and L5. Low signal intensity on T1 and T2 weighted images in the paraspinal soft tissues at this level are consistent with scarring and post-surgical change. There is a tract of fluid in the posterior soft tissues at this level that extends superiorly, which likely represents residual post-operative seroma. There is a residual extramedullary intraspinal lipoma extending from the level of L2/L3 to L4/L5 measuring 6.0 x 1.4 x 1.8 cm in its greatest dimensions (craniocaudal x transverse x AP). The cauda equina nerve roots at the upper L4 level abut the anterior dural surface secondary to mass effect and are displaced to the left. There is no evidence of a syrinx within the visualized spinal cord. There is ventral movement of the distal spinal cord cranial to the intraspinal lipoma with prone imaging. There are mild degenerative changes in the lumbar spine including disc bulge at L2/L3 which is eccentric to the right with associated moderate right neural foraminal stenosis. There is also disc bulge eccentric to the right at L3/L4 associated with mild to moderate right neural foraminal stenosis.
1. Post-operative changes related to prior myelomeningocele repair and recent cord untethering. A residual extramedullary intraspinal lipoma is present extending from L2/L3 to L4/L5 with associated mass effect and ventral displacement of the distal spinal cord/proximal cauda equina. Prone imaging demonstrates ventral motion of the distal spinal cord proximal to the lipoma. 2. Dextroscoliosis of the lower lumbar spine and mild degenerative changes at L2/L3 and L3/L4 with disc bulge and associated right neural foraminal narrowing as described above.