Case Summary ; 

This 16 year old male had a dimple over the lower back since birth and lower back pain for 6 months. He has no foot deformity/weakness or urinary incontinence. Bladder USS showed post void residue of 70ml without back pressure changes. MRI lumbosacral spine showed a low lying conus at L4 - L5 with a fatty filum terminale. Conus appeared to be attached to the dorsal dura at L4 level. The prophylactic nature of the surgery was explained to the parents (i.e. preventing further neurological worsening). He underwent L3-S2 laminectomy, untethering of cord and sectioning of fatty filum with intraoperative neuromonitoring.