Spinal Lipomas

Tethered cord syndrome and occult spinal dysraphism

“…7 Surgical intervention for the lipoma of the filum in the symptomatic or asymptomatic patient has been well described and is well tolerated. 48,74 In the symptomatic group, long-term follow-up review has demonstrated improvement or resolution of the presenting neurological or orthopedic abnormalities in 42.5% of patients, as well as stabilization of symptoms in 57.5%. 48 In the asymptomatic group, the great majority of patients remain asymptomatic in the long term and suffer no neurological worsening as a result of the operation.…”

“…7,52 Intraoperative monitoring of nerve roots may be useful to distinguish those that are functional from those that are not. 74 Once the spinal cord has been untethered, closure and enlargement of the dura with a graft material has been recommended. 52,74 In one study 7 of those patients younger than 1 year of age who underwent an untethering procedure for lipomyelomeningocele or fatty filum and who presented with motor, urological, or orthopedic symptoms, 39% improved, 58% stabilized, and 3% worsened as a result of surgical intervention.…”

“…74 Once the spinal cord has been untethered, closure and enlargement of the dura with a graft material has been recommended. 52,74 In one study 7 of those patients younger than 1 year of age who underwent an untethering procedure for lipomyelomeningocele or fatty filum and who presented with motor, urological, or orthopedic symptoms, 39% improved, 58% stabilized, and 3% worsened as a result of surgical intervention. 7 Surgical intervention for the lipoma of the filum in the symptomatic or asymptomatic patient has been well described and is well tolerated.…”

“…48 In the asymptomatic group, the great majority of patients remain asymptomatic in the long term and suffer no neurological worsening as a result of the operation. 48,74 Surgical intervention for the asymptomatic lipoma of the conus medullaris has been an area of controversy, 11,48,74 primarily because of the paucity of studies in which the natural history of this disorder is detailed. Many authors have advocated the use of early prophylactic untethering to prevent deterioration, 7,48 noting that asymptomatic patients rarely became symptomatic after the surgical procedure 32 and that a minority of symptomatic patients experienced reversal of their preoperative deficits.…”

“…7,48 Other authors have maintained that, in their series of patients, prophylactic untethering may not prevent some deterioration, and, because the natural history of the asymptomatic lipoma of the conus medullaris is not clearly known, prophylactic untethering may not be warranted. 74 A recent prospective study in which the authors examined the influence of surgery on the appearance of upper motor neuron signs in newborns with a tethered spinal cord (of various causes) 11 included 22 consecutive patients, 17 of whom had a lipomyelomeningocele. In approximately 29% of the patients with a lipomyelomeningocele, upper motor neuron signs were present at birth, and 60% of the asymptomatic patients with a lipomyelomeningocele developed upper motor neuron signs over a short period of 2 to 24 months postbirth.…”