Surgical Experience of 120 Patients with Lumbosacral Lipomas

Arai, Hajime; Satô, Kiyoshi; Okuda, Osamu; Miyajima, Masakazu; Hishii, Makoto; Nakanishi, Hajime; Ishii, Hisato

doi:10.1007/s007010170015

Cited by 113 publications

(79 citation statements)

References 13 publications

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“…Other studies have shown that minimally invasive open microscopic approaches with tubular and expandable retractors are sufficient to achieve the same goals as traditional open approaches (6,7). Surgical approaches for treating lipomyelomeningocele face significant risks for scar formation, nerve damage and spinal fluid leakage (4,5). The morphology of the lipomyelomeningocele in this case leant itself to a minimally invasive treatment because the lipoma tethered the cord to the filum instead of to the spinal cord.…”

Section: Discussionmentioning

confidence: 90%

“…The standard surgical approach is to partially resect the lipoma down to its neural attachment, section the filum terminale, and create a dural expansion graft to prevent future tethering. The complications inherent to this approach include spinal fluid leak, nerve damage, worsened bowel and bladder dysfunction, and re-tethering (4,5). Here we describe a minimally invasive endoscopic-assisted approach to untethering the spinal cord that illustrates several technical advantages to utilizing endoscopic visualization in cord untethering.…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive endoscopic spinal cord untethering: case report

Telfeian¹,

Punsoni²,

Hofstetter

2017

J. Spine Surg.

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Tethered cord syndrome is a constellation of symptoms and signs that include back and leg pain, bowel and bladder dysfunction, scoliosis and lower extremity weakness and deformity. Tethering may be due to a tight filum terminale or a form of spinal dysraphism. The authors present a case of a 40-year-old man who presented with symptoms of back pain, bilateral lower extremity radicular pain, and bowel and bladder dysfunction. Magnetic resonance imaging showed a sacral lipomyelomeningocele, with fat tracking superiorly to the conus, which was tethered at the L4-L5 level. A minimally-invasive surgical approach with endoscopic visualization and identification of the nerve roots and filum terminale was performed.The patient's postoperative clinical course was uneventful. This case highlights two important issues.First, minimally invasive spine techniques should be considered in the surgical treatment of tethered cord especially given the theoretical advantages of minimizing pain, spinal fluid leakage, and subsequent scarring.And second, endoscopic techniques are advancing. In the case presented here, endoscopic visualization and operative techniques made identification and transection of the filum terminale possible through a tiny dural opening. The small dural opening could theoretically pose the advantage of decreasing the risk of spinal fluid leakage. Clinicians should be aware that endoscopic visualization and techniques can serve as minimallyinvasive adjuncts to enhance the traditional approach to many surgical pathologies.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Minimally invasive endoscopic spinal cord untethering: case report

Telfeian¹,

Punsoni²,

Hofstetter

2017

J. Spine Surg.

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“…28 Surgically orientated classification of spinal lipoma was first proposed by Chapman and underwent various modifications based on MRI findings. 1,2,8,16,18 Chapman's classification is still useful today but does not account for spinal lipomas originating from failed secondary neurulation. Some have included the filum lipoma in the classification.…”

mentioning

confidence: 99%

“…Some have included the filum lipoma in the classification. 1 However, because this classification is simply based on the site and morphology of the spinal lipoma, it is now considered to have less clinical significance.…”

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confidence: 99%

New classification of spinal lipomas based on embryonic stage

Morota

Ihara

Ogiwara

2017

PED

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OBJECTIVE Spinal lipomas are generally thought to occur as a result of failed primary neurulation. However, some clinical features cannot be explained by this theory. The authors propose a novel classification of spinal lipomas based on embryonic changes seen during primary and secondary neurulation. METHODS A total of 677 patients with occult spinal dysraphism underwent 699 surgeries between August 2002 and May 2015 at the National Center for Child Health and Development and Tokyo Metropolitan Children's Medical Center. This group of patients had 378 spinal lipomas, including 119 conus spinal lipomas, 27 lipomyelomeningoceles, and 232 filum lipomas, which the authors classified into 4 types based on neural tube formation during embryonic development. Type 1 is defined as pure primary neurulation failure; Type 2 ranges from primary to secondary neurulation failure; Type 3 consists of secondary neurulation failure (early phase); and Type 4 is defined as secondary neurulation failure (late phase). The authors also review embryogenesis in secondary neurulation and analyze the clinical utility of the new classification. RESULTS There were 55 Type 1 spinal lipomas, 29 Type 2, 62 Type 3, and 232 Type 4. All filum lipomas fell into the Type 4 spinal lipoma category. Association with anorectal and/or sacral anomalies was seen in none of the Type 1 cases, 15 (52%) of Type 2, 35 (56%) of Type 3, and 31 (13%) of Type 4. Urogenital anomalies were observed in none of the Type 1 or Type 2 cases, 1 (2%) of Type 3, and 28 (12%) of Type 4. Anomaly syndromes were present in none of the Type 1 cases, 6 (21%) of Type 2, 3 (5%) of Type 3, and 16 (7%) of Type 4. Associated anomalies or anomaly syndromes were clearly observed only for Type 2–4 spinal lipomas encompassing failed secondary neurulation. Radical resection was feasible for Type 1 spinal lipomas. CONCLUSIONS Secondary neurulation of the spinal cord gives rise to the conus medullaris and filum terminale, which are often involved in spinal lipomas. Formation of spinal lipomas seems to be a continuous process overlapping primary and secondary neurulation in some cases. Association with other anomalies was higher in Type 2–4 spinal lipomas, which included failed secondary neurulation, than in Type 1 lipomas, with failed primary neurulation. On the other hand, radical resection was indicated for Type 1, but not for Type 2, spinal lipomas. The new classification of spinal lipomas based on embryonic stage has the potential for clinical use and agrees well with both clinical and surgical findings. The classification proposed here is still preliminary. Further studies and verification are necessary to establish its clinical utility.

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“…Lipomas of conus medullaris are further classified according to Chapman [6] into dorsal, caudal, and transitional lipomas. Intraspinal lipomas are most commonly found in the lumbosacral area (90%) [1,17,23,26]. Excluding the lumbosacral spine, the reported distribution of lipoma was thoracic in 32% of cases, cervicothoracic in 24%, and cervical in 13% [18].…”

Section: Discussionmentioning

confidence: 99%

Lateral tethering intraspinal lipoma with scoliosis

et al. 2010

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The authors present an unusual case of an intradural lipoma at the thoracolumbar level causing lateral tethering of the spine, with complicated scoliosis. A 6-year-old girl was admitted with progressive change in posture detected by her parents. Thoracolumbar scoliosis was detected by physical examination and X-ray studies. Spinal magnetic resonance imaging revealed an intradural lipoma and right lateral tethering of the spine at the upper lumbar level. After surgical release of lateral tethering and resection of the lipoma, fusion was performed by the orthopedic surgery team. Radiological and intraoperative findings of this extremely rare case are discussed.

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Surgical Experience of 120 Patients with Lumbosacral Lipomas

Cited by 113 publications

References 13 publications

Minimally invasive endoscopic spinal cord untethering: case report

Minimally invasive endoscopic spinal cord untethering: case report

New classification of spinal lipomas based on embryonic stage

Lateral tethering intraspinal lipoma with scoliosis

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