Abstract
Thirteen cases of lumbosacral spinal lipoma were described with respect to neurological assessment, neuroradiological examination and follow-up results.
The age ranged from 3 days to 25 years, and 38% of the patients were less than one year of age. The sex distribution revealed a preponderance of females over males at a ratio of 8: 5. No family history of spinal dysraphism was noted. A semifluctant soft tissue mass in the lumbosacral area was found in all of the cases. Five patients had other skin abnormalities in the area of the mass. Neurological examination was normal in three patients and abnormal in 10 patients. The commonest neurological abnormalities were bladder difficulty and motor weakness.
Three patients were symptom-free until the age of 5 months to 5 years. In five out of 10 cases in which a certain neurological abnormality was found, a history of apparent progression was obtained. Plain X-rays of the spine showed evidence of spina bifida occulta in all of the cases. Myelography was performed in 11 patients and unanimously showed abnormalities. Water soluble contrast medium (Metrizamide) was used in six cases. Surgery was performed in all the patients and six lipomyelomeningoceles, four lipomeningoceles and three lipomas were encountered. All of the cases were followed up for 2 to 6 years, with a mean follow-up period of 3 years. Three patients who had had no neurological abnormalities before surgery remained free of deficits for 3-4 years of follow-up. In four out of five patients, progressive deterioration which had been noted before surgery was arrested, although neurological deficits could not be completely resolved. These fatty swellings were apparently benign but they commonly had a continuation passing deeply to connect with the spinal cord, filum terminale, or cauda equina which was liable to injury by traction during the course of growth or by pressure owing to the increase in fat content within the theca. The authors believe that early corrective surgery can prevent the onset or progression of neurological complications. It is wise to perform myelography even before there are any signs of neurological involvement, and any abnormality in myelography justifies early preventive operations. The authors advocate preventive surgery as essential treatment for this disease.
