Sacral myolipoma with symptomatic contraction of the conus at standing on tiptoe

Introduction We present a case with spinal myolipoma that was unique in its anatomical composition and symptomatology. Case report An 18-year-old male presented with urinary retention and buttock pain exacerbated by standing on tiptoe underwent untethering of the low-set conus associated with a sacr...

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Bibliographic Details
Published in:European spine journal 2014-05, Vol.23 (Suppl 2), p.197-200
Main Authors: Shimizu, Satoru, Miyazaki, Tomoko, Mochizuki, Takahiro, Oka, Hidehiro
Format: Article
Language:English
Subjects:
Adipocytes
Adolescent
Case Report
Contraction
Electrical stimuli
Gastrocnemius muscle
Humans
Lipoma - pathology
Lipoma - surgery
Low Back Pain - etiology
Male
Medicine
Medicine & Public Health
Muscle contraction
Neurosurgery
Pain
Posture
Sacrum
Sacrum - surgery
Skeletal muscle
Spinal Cord Neoplasms - pathology
Spinal Cord Neoplasms - surgery
Surgical Orthopedics
Urinary Bladder, Neurogenic - etiology
Urinary Retention - etiology
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Summary:Introduction We present a case with spinal myolipoma that was unique in its anatomical composition and symptomatology. Case report An 18-year-old male presented with urinary retention and buttock pain exacerbated by standing on tiptoe underwent untethering of the low-set conus associated with a sacral fatty tract. Electrical stimulation of the spinal roots beside the upper conus induced anomalous caudal movement of the conus and contraction of the gastrocnemius muscle. In the lower conus, an ectopic muscle bridging the conus and dura was found, and the tissue contracted upon electrical stimulation. The histopathological diagnosis was myolipoma involving mature striated muscle and fat cells. Postoperatively his buttock pain was relieved immediately, but urinary retention persisted. Conclusion We posit that his buttock pain, exacerbated by standing on tiptoe, was due to traction of the conus by contraction of the ectopic muscle that was aberrantly innervated from the sacral spinal roots.
ISSN:0940-6719
1432-0932
DOI:10.1007/s00586-013-2966-3