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Updated: Jul 27, 2026
Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
Spinal lipomas in children
1Department of Paediatric Neurosurgery and Institute of Child Health, Birmingham Children's Hospital, Birmingham, UK.
Insights
Spinal lipomas can cause neurological issues. Prophylactic surgery may protect asymptomatic patients, while surgery for symptomatic filum lipomas is effective, but conus lipomas are challenging to manage.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Spinal Cord Disorders
Background:
- Spinal lipomas are a frequent cause of spinal cord tethering, potentially leading to progressive neurological deficits.
- The necessity of prophylactic surgery for spinal lipomas has been recently debated.
- This study reviews surgical outcomes for pediatric spinal lipomas treated at a single UK center.
Purpose of the Study:
- To evaluate the effectiveness of surgical intervention for spinal lipomas in children.
- To compare outcomes between asymptomatic and symptomatic patients, and different lipoma types (filum vs. conus).
- To assess the role of prophylactic surgery in preventing neurological deterioration.
Main Methods:
- Retrospective analysis of 59 children undergoing 69 surgical procedures for spinal lipomas between 1985 and 1999.
- Classification of lipomas into terminal, transitional, dorsal, and filum types.
- Follow-up data analyzed for neurological deterioration, functional improvement, and specific deficits like bladder dysfunction and motor problems.
Main Results:
- In asymptomatic patients, 26% experienced late neurological deterioration, including 21% of those with asymptomatic conus lipomas developing sphincter and motor issues.
- Symptomatic filum lipomas showed no postoperative deterioration, but significant long-term bladder dysfunction (39%) and neuro-orthopaedic deformity (54%).
- Symptomatic conus lipomas had a 67% improvement rate, but 74% experienced bladder dysfunction and 67% neuro-orthopaedic deformity, with limited return to normal function (45% motor problems).
Conclusions:
- Spinal lipomas can cause progressive deficits regardless of surgical intervention.
- Filum lipomas are generally benign with safe and effective surgical outcomes.
- Conus lipomas present management challenges; prophylactic surgery may offer protection for asymptomatic cases, and surgery can halt deterioration in symptomatic cases, though full functional recovery is limited.
Abstract:
Spinal cord lipomas are a common cause of cord tethering that can lead to progressive neurological defects. The role of prophylactic surgery for spinal lipomas has recently been questioned. Between 1985 and 1999, 59 children underwent a total of 69 surgical procedures at the Birmingham Children's Hospital in Birmingham, UK. The spinal lipomas were classified into: 18 terminal, 17 transitional, 6 dorsal and 18 filum lipomas - including 12 who had a typical thickened filum terminale. At the first operation, 19 patients (32%) were asymptomatic, and 40 patients (68%) presented with symptoms. Surgical indications in the asymptomatic group included the presence of a dermal sinus tract or syrinx. Prophylactic surgery was undertaken in selected cases. The mean total follow-up for the group since the first surgical procedure was 61.8 months (range: 7.0-203.0 months). In the asymptomatic group, 26% of the patients had late neurological deterioration. Of the 14 patients with asymptomatic conus lipomas, 3 (21%) developed sphincter dysfunction and motor problems at long-term follow-up. In the symptomatic group, 68% improved, 20% remained unchanged, and 12% had late neurological deterioration. None of the 18 patients with symptomatic filum lipoma deteriorated postoperatively. However, 39% had bladder dysfunction, 54% had neuro-orthopaedic deformity, and only 15% returned to overall normal function at latest follow-up. Of the 27 patients with symptomatic conus lipomas, 67% improved, 15% remained stable, and 18% had late neurological deterioration. However, 74% had bladder dysfunction, 67% had neuro-orthopaedic deformity, and 45% had motor problems at long-term follow-up. Spinal lipomas can cause progressive neurological deficits irrespective of spinal untethering surgery. This study demonstrates that filum and conus lipomas have similar clinical presentation, but differ in their outcome following surgery. Filum lipomas are 'benign', for which surgery is safe and effective. Conus lipomas are more difficult to manage. When asymptomatic, our results suggest that prophylactic surgery does provide some protection from future neurological deterioration. When symptomatic, conus lipoma surgery is effective in stopping further deterioration. Improvement in neurological function can occur, but few patients return to normal overall function, and pre-existing sphincter dysfunction is not significantly altered by surgery.
