Total excision of spinal lipomas using CO2 laser at low power. Experimental and clinical observations

Total excision of spinal lipomas (SL) is difficult because of the intimate adhesion between the fibro-adipose tissue and the neural structures. Radical surgery in SL can provoke nervous lesions; therefore many authors recommend only partial excision as a means of decompression. Nevertheless the role of traction or tethering of the spinal cord in all spinal disraphism, including SL, is known to be very important in determining the clinical picture. So partial removal of SL cannot be effective in releasing the tethered cord. The use of a CO2 laser at low power (3-5 W) permitted radical surgery without any neural damage and complications in 2 adult patients with large, not well capsulated SL. These patients were previously operated on by the same surgeon with conventional microsurgical techniques for partial excision. After CO2 laser surgery there was significant improvement of the clinical pictures, the follow-up being respectively 24 and 36 months. This clinical experience was performed after a CO2 laser had successfully been used in an experimental model in rats simulating a condition of SL. Using power of 3-5 W was not sufficient to attain an immediate vaporization, but the adipose tissue first changed into a transparent liquid across which it was possible to recognize the interfaces between the neural structures and the adipose tissue.