Cervical Lipomyelocele with Congenital Inclusion Cyst

Spinal dysraphism refers to a group of congenital malformations affecting the spine and the spinal cord. Although there are several varieties, all have one thing in common, i.e., faulty closure of midline structures at embryogenesis. Rarely, these anomalies are associated with spinal inclusion cysts. Lipomyelocele (LMC) is a type of spinal dysraphism wherein the neural elements along with fat herniate through a posterior defect in the spine. A vast majority of these anomalies are seen in the lumbosacral region, and their occurrence in the cervical region is extremely rare.

A 45-year-old female patient presented with swelling over the nape of her neck since birth, with recent-onset paresthesia and unsteady gait. On local examination, a soft fluctuant swelling with blackish discoloration of skin was noted at the nape of the neck. Radiographs revealed congenital C4-C5 block vertebra with defect in posterior elements from C4 to C6. Magnetic resonance imaging revealed a cervical LMC with extramedullary intradural congenital inclusion cyst. Other notable findings were dorsal dermal sinus in cervical region, low lying tethered cord, and aberrant right subclavian artery. In our literature review, we could find only 1 case report of a cervical LMC and no cases reported of cervical LMC with congenital inclusion cyst.

Herein, we report a case of a cervical LMC with a spinal inclusion cyst.