0:01

I did want to compare and contrast two different

0:03

entities, the lipoma of the filum terminale

0:07

and the fatty infiltration of the filum.

0:10

The fatty infiltration of the filum is considered a

0:13

normal variant and is usually not symptomatic and is

0:16

not associated with tethering of the spinal cord.

0:20

Lipomas of the filum,

0:22

or the conus medullaris are often associated

0:25

with tethering of the spinal cord.

0:27

So, let me show the difference here.

0:29

These are both children.

0:30

This is the first case where we have a patient

0:32

who has a lipoma, which is associated with

0:35

the termination of the spinal cord

0:37

here at the L3 level,

0:39

the cord is a little bit low.

0:41

This is a mass, and as you can see,

0:44

there is some bulk to this lesion associated

0:48

with the of the conus medullaris.

0:52

So, low conus ending here at about L3,

0:56

and a bulky lesion in the thecal sac.

1:00

Let's compare that with the fatty infiltration

1:03

of the filum case, which is seen here.

1:06

So here we have...

1:08

the abnormality is, again, at the L3 level.

1:11

However,

1:11

we note that the cord has ended at the

1:14

appropriate T12-L1 level.

1:16

So, this is in a lower location without

1:18

tethering of the spinal cord.

1:20

And although it's bright in signal intensity,

1:23

it is small in size.

1:26

And this is what we would use the term

1:29

fatty infiltration of the filum.

1:31

Why are we using that term?

1:33

So, the difference is that someone hears lipoma,

1:36

they think, oh,

1:36

I've got a fatty tumor of the spinal cord or of

1:40

the filum, and are more worried about it,

1:42

and it's associated with tethering.

1:44

By saying the term fatty infiltration of the filum,

1:46

we're essentially calling it a normal variant.

1:50

Both of these are going to show suppression

1:54

on the STIR imaging,

1:55

and you would see it as the darker signal intensity,

1:58

whether it's the infiltration of the filum,

2:01

or in the example of a patient who has a lipoma,

2:07

which also, because of the fat, will

2:10

suppress on the STIR imaging.

2:12

So two different cases, a lipoma at the conus

2:16

medullaris and filum with associated low spinal

2:19

cord or tethering, versus the kind of normal

2:23

variation of fatty infiltration of the filum.