Adult intradural lipoma with tethered spinal cord syndrome.

A 48-year-old woman presented to our imaging department with lumbar sciatica. The patient had a medical history of low back pain and spina bifida. A transverse section lumbar spine CT-scan, obtained with soft-tissue window setting (Fig. A, arrow) showed, a fat-density (45-HU), oblong, posterior intradural supracentimetric lesion, at level of L5-S1. The use of bone window setting revealed a spina bifida at L4-L5-S1 (Fig. B, arrow). Lumbar spine MRI performed shortly afterwards confirmed the presence of a posterior intradural supra centimetric lesion, at level of L5-S1, hyperintense on T1 (Fig. C, arrow) and T2, and hypointetense on T2 Stir weighted imaging (Fig. D, arrow), and showed that the filum terminale was attached to the aforementioned lesion. It also demonstrated that the conus medullaris was in an abdormally low position, set at the spinal level of L3-L4. Intradural spinal lipoma with tethered spinal cord was diagnosed. The patient will benefit from physiotherapy and a surgical option could be envisaged according to the clinical evolution.