Vol. 7, Issue 1, Part B (2025)

Infants with lower back soft tissue swellings in natal cleft region usually have disorders of the spinal dysraphism spectrum like lipomeningomyelocele or terminal lipomas. However, spinal osteolipomas- rare lipoma variants containing osseous elements- remain a underrecognized entity. We present the youngest case of lumbosacral osteolipoma in an eleven-month-old infant presenting with a midline swelling, without any neurological symptoms or developmental abnormalities. While we initially suspected a lipomeningomyelocele based on the location, surgical exploration revealed a lipomatous swelling with a central osseous component, lacking spinal communication. Histopathological analysis confirmed the diagnosis of osteolipoma of the lumbosacral spine. This case highlights the diagnostic challenge of spinal osteolipoma, especially in infants, and reinforces the importance of timely surgical excision for accurate diagnosis and prevention of neurological complications.