Asymptomatic lumbosacral lipomas—a natural history study

Abstract

This study suggests that the natural history of this subgroup of dysraphic patients may be more benign than hitherto considered. Conservative management with adoption of a novel surveillance policy and timely intervention only in the presence of symptomatic deterioration resulted in 71% of this series remaining clinically asymptomatic at mean follow up period of 5.9 years (range, 1.0-19.3 years). At 10 years, the cumulative risk of deterioration determined by the Kaplan-Meier method was 40%. Children aged<2 years, female, with presence of a transitional type of LSL and associated syrinx were independently associated with a higher risk of deterioration.

Radiographic predictors of deterioration in patients with lumbosacral lipomas

“…10,17,18,24 Clinical assessment is further challenging given the presentation at infancy and the presence of congenital neurological deficits.3 Magnetic resonance imaging allows the anatomy of the malformation to be characterized.The BCCH Spinal Cord Clinic (SCC) is the sole clinic to provide comprehensive multidisciplinary assessment and regular follow-up for patients with spinal dysraphism in British Columbia. The clinic provides families of infants with lumbosacral lipoma with the available natural history data and surgical treatment results and offers families 2 management options: 1) prophylactic resection of the lipoma and untethering of the neurological structures, or 2) regular multidisciplinary review with operative intervention when the patient shows indication of a new deficit.…”

“…10,17,18,24 Clinical assessment is further challenging given the presentation at infancy and the presence of congenital neurological deficits. 3 Magnetic resonance imaging allows the anatomy of the malformation to be characterized.…”

Symptomatic retethering of the spinal cord in postoperative lipomyelomeningocele patients: a meta-analysis

“…Wykes et al [31] performed a study on asymptomatic children tracking their progress to deterioration, and Kaplan-Meier survival analysis predicted 40 % chance of deterioration at 10 years. This is sooner than the predicted 12.33 years for LMM predicted after surgery with our model, but we concede that it is impossible to adequately compare.…”

Spontaneous improvement in urological dysfunction in children with congenital spinal lipomas of the conus medullaris

“…12,29,34 Several authors have advocated for prophylactic cord detethering surgery in asymptomatic patients. 2,5,11,12,14,18,22,30,31,33 One purported rationale for this relates to evidence suggesting that once neurological deficits have manifested, only a minority of these patients will improve after surgery, whereas asymptomatic patients only rarely develop symptoms after prophylactic surgery.…”