A 40-year-old man presented with a three-year history of progressive back and bilateral leg pain and some urinary hesitancy. There was a dimple over the lumbar spine covered with hair and 4/5 proximal strength in the iliopsoas.
MRI demonstrated a fatty filum terminalae and dermal sinus which tracked through the posterior spinous process of L4 and led to a collection of CSF density at L3/4 best seen on T2 sequences.
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