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Spontaneous improvement in urological dysfunction in children with congenital spinal lipomas of the conus medullaris
Jetan H Badhiwala1, Eric M Thompson, Armando J Lorenzo
1Michael G. DeGroote School of Medicine, McMaster University, Hamilton; and.
Insights
Congenital spinal lipomas of the conus (SLCs) can improve spontaneously in infants. These cases show improved urinary function, highlighting the dynamic nature of neurological compromise in SLC.
Area of Science:
- Pediatric Neurology
- Urology
- Developmental Neuroscience
Background:
- Congenital spinal lipomas of the conus (SLCs) are common closed neural tube defects.
- The optimal treatment for SLC remains controversial due to an incomplete understanding of its natural history.
- Assessing the natural progression of SLC is crucial for guiding clinical management.
Observation:
- Two infants presented with congenital spinal lipomas of the conus.
- Both infants exhibited compromised lower urinary tract function, confirmed by urodynamic studies.
- Long-term follow-up revealed spontaneous improvement in urodynamic parameters.
Findings:
- The observed cases demonstrated spontaneous improvement in lower urinary tract function in infants with SLC.
- Urinary function stabilized to normal levels in the long-term follow-up period.
- This contrasts with radiological regression, which rarely reverses existing neurological deficits.
Implications:
- These findings suggest that neurological deficits associated with SLC may exhibit a dynamic course.
- Further research into the natural history of SLC is warranted to refine treatment strategies.
- The potential for spontaneous functional recovery in SLC should be considered in clinical decision-making.
Abstract:
Congenital spinal lipomas of the conus (SLCs) are among the most common closed neural tube defects. The treatment of SLC is an area of controversy because the true natural history of this condition is unknown. Here, the authors present two cases of SLC presenting in infancy with compromised lower urinary tract function, which was objectively confirmed by abnormal urodynamic studies. In both cases, there was spontaneous improvement in urodynamic parameters, with stable normal urinary function at the long-term follow-up. Although cases of spontaneous radiological regression of SLC have very infrequently been reported, they have not been associated with the reversal of already present neurological deficits. This report reinforces the need for further delineation of the true natural history of SLC and highlights the dynamic nature of associated neurological compromise over time.
