Neurocysticercosis is commonly seen intracranially, intravertebral cysticercosis is rare, and isolated intravertebral cysticercosis is extremely rare. A patient with isolated cauda equina neurocysticercosis was admitted to our hospital and is reported below. The patient was a 25-year-old male with lumbar discomfort after a lumbar sprain 10 years ago, and the symptoms were relieved after conservative treatment with local closure, but there was still intermittent lumbar discomfort. 3 years ago, the symptoms were relieved significantly and there was no further pain. 1 month ago, lumbar pain reappeared after lifting heavy objects, radiating to both lower limbs to the thighs and knees, and the pain was obvious at night and persisted without relief. MRI: irregular long T1-long T2 signal shadow was seen in the lumbar 2-4 spinal canal, with a size of about 82*9.3 mm, and cystic enlargement of the subarachnoid space caused by the intradural recess at the level of lumbar 4. The dura was strengthened and thickened at the lesion site on enhancement scan. The adjacent cauda equina was displaced. Combined with the patient’s closed medical history and MRI performance, cauda equina abscess was considered not excluded. A lumbar 3 and 4 laminectomy was performed and the arachnoid was found to be adherent to the dura mater, with the caudal side being heavier, and the adhesions were separated. The arachnoid membrane was thickened, the subarachnoid space was in high tension, and the cauda equina was located dorsally. After dissection of the arachnoid, a lobulated cyst was seen to emerge, approximately 2*1 cm in size, with an intact envelope, translucent, and complete excision, with cerebrospinal fluid emerging from the cephalic end and restoration of dural sac pulsation. The cauda equina nerve adhesions were heavy and thickened membranous material was seen in the subarachnoid space. The thickened membranous material was excised and the nerve root adhesions were released. Postoperative pathology showed cysticercosis, and the patient’s neighbors had a history of eating “rice pork”. Further cranial CT and MRI did not show any intracranial abnormalities. The patient’s symptoms resolved and he was discharged. Intratentorial cysticercosis accounts for only 1.6-13% of neurocysticercosis [1]. Isolated intravertebral cysticercosis is very rare, accounting for only 25% of intravertebral cysticercosis [2, 3], and is the direct entry of six hookworms into the spinal canal through the blood or lymphatic circulation, often presenting as intramedullary cysticercosis [3, 4]. Because the blood supply to the spinal canal is only 1/100th of that to the brain, this may explain the low incidence of intradural cysticercosis [5]. Symptoms in patients with intravertebral cysticercosis are related to the location, size and the presence of an inflammatory response [1-3, 5-7]. Mostly painful, the pain is predominantly low back and leg pain. Patients often have varying degrees of spastic paralysis, increased muscle tone, hyperreflexia or the presence of pathological reflexes. If the cysticercus larvae are parasitized in the cone cauda equina site, they may show decreased perianal sensation or difficulty with diaphoresis. It may also manifest as arachnoiditis, hydrocephalus, etc [3]. However, these manifestations are not specific and the diagnosis is more difficult in the absence of a history of neurocysticercosis or concomitant intracranial cysticercosis [2]. Patients may present with increased eosinophilia or calcification of soft tissues, but this is relatively rare [8]. Cerebrospinal fluid examination shows increased lymphocytes, elevated protein levels, normal or slightly low glucose levels, and visible eosinophils [3]. On MRI, it often shows low signal on T1WI and high signal on T2WI with peripheral edema and circumferential enhancement after enhancement [9, 10]. The head segment, on the other hand, shows high signal on T1WI and low signal on T2WI, which is an important basis for diagnosis [9]. However, cephalic segments are uncommon in intravertebral cysticercosis, the MRI presentation is not specific, and the imaging diagnosis is more difficult in the absence of concomitant intracranial cysticercosis [2, 9, 11]. The incidence of intravertebral cysticercosis is low, and its clinical and imaging manifestations are often nonspecific; therefore, intravertebral cysticercosis should be considered in conjunction with a history of “rice pork” consumption, blood or cerebrospinal fluid immunoassay, and cerebrospinal fluid examination [1, 2]. Intradural exploration and removal of cysticercosis is the treatment of choice when spinal cord or nerve root compression symptoms are present [1, 3, 6, 8, 10-12]. Moreover, when the diagnosis is still unclear, surgery helps to obtain a definitive pathological diagnosis [6, 12]. Due to the limited space in the spinal canal, intravertebral cysticercosis is prone to irreversible neurological dysfunction and therefore surgery should be performed promptly [3, 6, 8, 10, 11]. Cure of intralesional cysticercosis with medication has also been reported, but is limited to patients with stable symptoms without progressive exacerbation [3, 4, 6]. Commonly used drugs include albendazole, praziquantel, and/or steroids [12]. Since there are other pathogenesis of intralesional cysticercosis than mass compression, and the presence of cysticercosis elsewhere in the body (especially cerebral cysticercosis) cannot be excluded, postoperative anti-cysticercosis medication is necessary at the appropriate time [2]. A total neuraxial examination should also be performed to detect occult lesions [5].