Abstract
Early prophylactic surgery for asymptomatic spinal lipomas remains a topic of debate and an appropriate consensus has not been reached. To solve this problem a randomized controlled trial is proposed, but there are problems such as the difficulty of matching the two groups and ethical reasons.
The authors analyzed the clinical pictures of 158 spinal lipoma patients regarding their neurological deficits, and investigated the long-term follow-up results of 51 asymptomatic patients who were followed over 7 years after surgery.
Eighty-six asymptomatic patients and 72 symptomatic patients were included in this study. Sixty percent of lipomyelomeningocele (LMMC) or transitional type case were symptomatic. Sixty-seven percent of the operations were conducted in the patient's first year of life. Median age at the first operation was 0.45 years, 0.4 years for asymptomatic and 0.7 years for symptomatic. During the long-term follow-up periods (7.6 years～25.4 years) of 51 asymptomatic patients, 10 of them (19.6%) presented with neurological deficits and 5 (9.8%) received a second untethering.
LMMC, sacral lipoma, and large lipoma are likely to develop neurological deficits in the first year of life. Spinal herniation, early diagnosis of neurogenic bladder with urological study, and neural compression by large lipoma were considered to be the cause of early clinical deterioration.
In conclusion, from our results, LMMC, sacral lipoma, and large lipoma were considered best to be operated on by the age of one year old and other types of lipomas such as dorsal or filar type by the age of three years old.
