Imaging of intradural lipoma with tethered cord and herniation through spinal defect: A case report

Introduction: Spinal dysraphism encompasses congenital anomalies from defective neural tube closure, ranging from occult forms to severe myelomeningocele. Intradural lipomas, rare benign tumors (∼1% of spinal cord masses), are often linked to tethered cord syndrome and spina bifida. These fatty lesions, typically dorsal, may herniate through spinal defects, exacerbating neurological deficits via compression or tethering.  This report presents a case of intradural lipoma with tethered cord and herniation.

Case Report: A 26-year-old female presented with progressive lower back pain, leg weakness, and urinary incontinence. Physical exam revealed a lumbosacral subcutaneous mass. MRI confirmed an intradural lipoma (L3–S1) with tethered cord and herniation through an L5–S1 spinal defect.

Discussion: MRI is the gold standard investigation for diagnosis of Spinal lipoma with its herniation. It is seen as T1 hyperintensity lesion (fat signal) with fat-suppression confirmation associated with herniation through a posterior defect. Symptoms usually result from cord tethering and mass effect, often progressive without intervention.

Conclusion: Intradural lipomas with herniation are rare but require early MRI diagnosis and timely surgery to prevent irreversible neurological damage.