Traumatic lumbar pseudomeningocele occurring with spina bifida occulta

Pseudomeningocele in the lumbar spine due to spinal fractures or surgical procedures are well-recognized complications. We treated a 24-year-old man who fell from a horse, landing on his buttocks, and developed headaches, back pain, and a large lumbar subcutaneous fluid collection. Plain radiographs and magnetic resonance (MR) imaging revealed a midline defect in the sacral lamina and a large fluid collection in the subcutaneous space consistent with cerebrospinal fluid (CSF). He was treated conservatively, his symptoms resolved, and follow-up MR imaging showed resolution of the CSF accumulation. To our knowledge, there have been no cases of traumatic pseudomeningocele related to spina bifida occulta reported in the literature. The authors postulate that congenital defects in the neural arch contribute to the occurrence of this entity, and nonsurgical treatment should be the initial course.