2018 Volume 32 Issue 3 Pages 329-333
A 49-year-old man with lumbar spinal lipoma was surgically treated because of intractable pain. The lipoma was originally asymptomatic and found incidentally 10 years before. He began to have occasional dysesthesia in the right lower limb 8 years before. The symptom became severe 1 year before he visited our hospital for the first time. The dysesthesia was in the L5 region of his right lower limb. Muscle weakness and urinary incontinence were not found. The magnetic resonance imaging demonstrated low-set conus (L3/L4) associated with spinal lipoma, which extended from the extradural part (from L4/L5 to L5/S1) to the intradural part (from L2/L3 to L3/L4). Computed tomography revealed hypoplasia in the laminae of L4, L5, and S1. We observed him for a year, and the dysesthesia became intolerable while the lipoma size was unchanged. Untethering was performed with L2-L5 laminectomy. The extradural part of the lipoma was completely removed with the adhered dural membrane. The intradural part was detached from dural membrane and partially removed. A GORE-TEX patch was used for dural membrane closure. The mechanism of adult-onset spinal lipoma is considered tethered cord syndrome or spinal cord compression. As spinal lipoma is usually adhered with the spinal cord, the appropriate surgical strategy seems to be untethering and partial resection of the lipoma.
