Author:

Keywords:

Adolescent, Adult, Female, Humans, Infant, Lipoma, Lumbosacral Region, Male, Middle Aged, Neural Tube Defects, Retrospective Studies, Spina Bifida Occulta, Spinal Cord Neoplasms, Surgical Procedures, Elective, Time Factors, Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Pediatrics, Surgery, Neurosciences & Neurology, lumbosacral lipoma, tethered cord, spina bifida occulta, complications, prophylactic surgery, TETHERED CORD SYNDROME, Elective Surgical Procedures, 1103 Clinical Sciences, Neurology & Neurosurgery, 3202 Clinical sciences, 3209 Neurosciences

Abstract:

We retrospectively reviewed 32 patients operated on for lipoma of the conus and lipomyeloschisis, the two main anatomical subtypes of congenital lumbosacral lipomas associated with tethered cord syndrome. Surgery was proposed to patients when they were symptomatic, and in most cases for progressive symptoms. The evolution of the different symptoms was studied separately. In most patients, symptoms improved or stabilized after surgery; in some, however, postoperative worsening, at least of some of the symptoms, was seen. This postoperative worsening became apparent either early or late after the operation, and was not associated with surgical trauma or postoperative complications. We suggest it was caused mainly by the natural course of the disease (especially in the case of the orthopedic deformities), and in some cases by retethering. Our series is not large enough to detect statistical significance for the different symptoms or for the anatomical subgroups. Importantly, according to our analysis by the different symptoms, the operation did not seem to protect the patients from later development of new deficits. This can be interpreted as an argument against prophylactic surgery in asymptomatic patients.