Spina bifida without mention of hydrocephalus, lumbar region Other specified congenital anomaly of spinal cord Backache, unspecifiedClinical question: history of Lipomyelomeningocele, tethered cord release , pt with new back pain, eval for retethereing,Signs and Symptoms: abnormal neurological exam(gait, pain) eval for changes MRI thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is redemonstration of a lipomyelomeningocele with tethering of the cord. The lipoma extends from L3 to L5. The cord joins the lipoma at L3. From supine to prone there is forward movement of the spinal cord above the level of the lipoma. Since the prior exam there appears to be more fat accumulation within the intrathecal portion of the lipoma. The AP dimension of the lipoma is 22mm on the current and 17 mm on the prior exam. A cystic lesion along the right posterior aspect of the spinal canal at the L3 and L4 vertebral levels has rearranged relative to this fat accumulation. There is accumulation of significantly more subcutaneous fat since the prior exam. Interestingly at L4-5 a previously present Schmorl's node is smaller on the current exam and the disk space height has increased by a couple millimeters. The lumbar lordosis on the other hand is exaggerated relative to the prior exam. There is spina bifida present.The patient is status post lumbar spine surgery. At L5-S1 there is no significant compromise to spinal canal or neural foramina. The distorted configuration of the thecal sac is unchanged and the intrathecal nerve roots are displaced peripherally in similar positions as on the prior exam. At L4-5 there is no significant compromise to spinal canal or neural foramina. At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Since the prior exam from 2010, there has been fatty accumulation within the spinal canal at the L3 and L4 levels but otherwise no change in the lipomyelomeningocele. Movement of the cord from supine to prone is unchanged.