The patient is an Iraqi child came to the clinic 22-April-2012. The parents notices a lump in the middle of the lumbar area since birth.

MRI of the lumbar spine performed 23-October-2011 of bad quality.

The patient is neurologically free with a lump in mid of the lumbar area with bony deformity more prominent in the left side. The skin over the lesion is intact but pulsating with CSF felt under the skin. There is slight atrophy of the right scapula in comparison with the right.

The patient was sent to perform MRI of the brain and the cervical spine and the lumbar area with contrast. It was done 24-April-2012 confirming the presence of small lipoma and tethering of the spinal cord to the neck of the sac. MRI of the brain and cervical spine were normal.

Skeletonization of L3, L4 and L5 was done. The bony lesion which was not in continuity with the spinal column was removed. Partial laminectomy of L3 was done to expose the dura and downward dissection was carried out until the sac was identified and dissected off. The CSF is coming free from the dural defect. The defect was inspected and the lipoma was still tethering the cord above the defect, for what, complete laminectomy of L3 was done and the dural defect was extended upward around 12 mm. The lipoma was identified and partial resection down to the boundaries of the neural structures to preserve them and to have complete untethering of the spinal cord. All the tethering elements were sharply dissected including the arachnoid layers. Water tight closure of the dura.

Routine closure of the wound. Smooth postoperative recovery.

The aim of the surgery is to untether the spinal cord and to yield the cushioning effect of the dural defect due to mechanical irritation.