Case: A 79-year-old woman presented with persistent left leg pain following right-sided L4-5 minimally invasive transforaminal lumbar interbody fusion. Imaging studies revealed residual left L4-5 stenosis, a filum terminale lipoma, and no bone bridging. Additional left L4-5 decompression with reinstrumentation achieved temporary relief, but complete pain resolution was achieved only after sectioning of the filum terminale lipoma causing the tethered cord syndrome.
Conclusion: Although rare, the coexistence of lumbar spinal stenosis and filum terminale lipoma can occur, and even in cases presenting with radicular leg pain, the potential contribution of the lipoma to the symptomatology should not be dismissed.
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