Background: Spinal dermoid cysts are rare congenital tumours, accounting for approximately 1% of spinal tumours. Rupture of these lesions is uncommon, and dissemination of lipid material typically occurs into the subarachnoid or intraventricular spaces. Isolated rupture with lipid spread into the central canal is exceptionally rare. Case Presentation: We report the case of a 20-year-old male who initially presented with bilateral lower limb weakness and urinary disturbances. Baseline MRI revealed a heterogeneous conus mass without evidence of rupture. During follow-up, the patient developed progressive neurological deficits over two years. Repeat MRI demonstrated multiple lipid droplets within a dilated central canal, consistent with rupture of the conus dermoid. Discussion: While ruptured spinal dermoid cysts have been described, dissemination of lipid material confined to the central canal is exceedingly uncommon. This case underscores the importance of long-term follow-up, as delayed rupture can result in progressive neurological deterioration. MRI plays a crucial role not only in identifying the primary lesion but also in tracking unusual dissemination patterns. Conclusion: Ruptured conus dermoid cysts with lipid dissemination into the central canal are rare. Early recognition and vigilant follow-up are essential for timely intervention and prevention of irreversible neurological deficits.