Congenital lumbosacral lesions with late onset in adult life.

Seven adult patients with congenital lumbosacral lesions and clinical onset in adult life are reported. All also had an abnormally low and tethered spinal cord. A thickened filum terminale and a spinal lipoma are the most common lesions in adults, whereas others, including diastematomyelia, fibrous adhesions, previous meningocele repair and dermal sinus are more rare. Although water-soluble myelography visualizes the abnormally low conus well and may diagnose a diastematomyelia and a thickened filum, computerized tomography, CT myelography and magnetic resonance may provide a better diagnostic definition of the other abnormalities. Surgical treatment should be performed in all adult patients with progressive symptoms. Transection of the thickened filum or of fibrous adhesions and the removal of a spinal lipoma, diastematomyelia septum or dermal sinus tract, result in remission of the pain and improvement of the sensorimotor deficits, or at least prevent the progression of the neurological troubles.