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Orthopaedic deformities associated with lumbosacral spinal lipomas
Prasad Gourineni1, Luciano Dias, Ronaldo Blanco
1Department of Orthopaedics, University of Illinois, Illinois, USA. gourineni@hotmail.com
Insights
Occult spinal dysraphism, often presenting as lipomeningocele, frequently causes musculoskeletal issues, particularly foot deformities. Surgical intervention for these foot problems in children is generally successful, highlighting the need for early detection and management.
Area of Science:
- Pediatric Orthopaedics
- Neurology
- Spinal Surgery
Background:
- Lipomeningocele is the most frequent cause of occult spinal dysraphism and spinal cord tethering.
- Patients often present with musculoskeletal complaints and cutaneous signs, appearing normal at birth.
Purpose of the Study:
- To investigate the spectrum of orthopaedic deformities in patients with lipomeningocele.
- To analyze the characteristics and treatment outcomes of foot deformities in this population.
Main Methods:
- Retrospective case study of 159 patients diagnosed with lumbosacral spine lipoma.
- Detailed analysis of 122 patients treated by a single orthopaedic surgeon, with a focus on 45 patients over 15 years old at final follow-up.
Main Results:
- Foot deformities were the most prevalent orthopaedic issue (44.2% in patients >15 years), followed by scoliosis.
- Common foot deformities included cavovarus, cavus, and equinocavovarus, with 70% achieving good correction in a single surgical procedure.
- Surgical approaches varied by age, with soft tissue procedures for younger children (<8 years) and bony procedures for older children (>11 years).
Conclusions:
- Orthopaedic deformities, especially foot deformities, are common in occult spinal dysraphism and often require surgical intervention.
- Early clinical suspicion and thorough evaluation are crucial for detecting spinal cord anomalies and preventing deformity progression.
- Surgical treatment for foot deformities is typically successful, emphasizing the importance of routine follow-up and muscle strength testing.
Background:
Lipomeningocele is the most common cause of occult spinal dysraphism and spinal cord tethering. Children with this condition seem normal at birth except for cutaneous signs, and the initial complaints are usually musculoskeletal. We studied the orthopaedic deformities observed in this condition.
Methods:
We reviewed the medical charts of 159 patients with a diagnosis of lipoma of the lumbosacral spine that were examined in the Myelodysplasia Clinic over 25 years. Of these patients, 122 were treated by a single orthopaedic surgeon (L.D.) and were studied in detail. Of these 122 patients, 45 were over 15 years of age at the time of the final follow-up.
Results:
Most patients had cutaneous stigmata. Foot deformities were the most common orthopaedic problems, followed by scoliosis. In patients over 15 years of age, the incidence of foot deformities was 44.2% (36 feet), with 20 feet requiring surgical treatment. The most common foot deformities were cavovarus, cavus, and equinocavovarus. In 70% of the surgical cases, good correction was achieved with only one procedure. Foot surgeries in patients under the age of 8 years were usually soft tissue procedures, and bony procedures were performed primarily in patients over the age of 11 years.
Conclusions:
Orthopaedic deformities are common at the initial presentation in patients with occult spinal dysraphism. A careful clinical examination with a high index of suspicion for spinal cord anomalies is indicated in all cases of spinal and lower extremity deformities. Foot deformities are very common and surgical treatment is usually successful. A thorough follow-up evaluation, including manual muscle strength testing, should be performed routinely to detect tethering of the cord in the early stages and to prevent worsening of the orthopaedic deformities.
Level Of Evidence:
This was a retrospective case study. Level 4.
