Symptomatic cervical lipomyelomeningocele in an adult: illustrative case.

backgroundCervical lipomyelomeningocele (LMMC) is an exceedingly rare form of spina bifida occulta. Cervical LMMC presenting in adulthood, particularly in the 4th decade, as cervical tethered cord syndrome is extremely uncommon. OBSERVATIONS: The authors report the case of a woman in her early 40s who presented with clinical features of cervical compressive myelopathy. Neuroradiological evaluation showed cervical LMMC extending from C3 to C6, along with significant compression and flattening of the spinal cord. The patient underwent C3-6 laminectomy and excision of the lipomatous tissue, along with untethering of the cervical spinal cord under intraoperative neuromonitoring (IONM). Histopathological examination confirmed lipomatous tissue. Postoperatively, the patient demonstrated clinical improvement in spasticity and extremity weakness. Follow-up imaging showed satisfactory decompression and expansion of the cervical spinal cord. LESSONS: Symptomatic cervical LMMC in adults is exceedingly rare. While asymptomatic cases may be managed conservatively with regular surveillance, excision of the lipoma with cord untethering remains the treatment of choice in symptomatic patients. The use of IONM provides an important safeguard during resection, minimizing neurological morbidity. https://thejns.org/doi/10.3171/CASE25771.