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Does conus morphology have implications for outcome in lumbosacral lipoma?
Dominic N P Thompson1, Jochem Spoor2,3, Martje Schotman2,4
1Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Trust, London, UK. dominic.thompson@gosh.nhs.uk.
Summary
Dorsal lumbosacral lipomas (LSL) with visible conus on MRI show good outcomes. Conus integrity, not just its level, is key for prognosis, supporting selective surgery for LSL.
Area of Science:
- Pediatric Neurosurgery
- Spinal Cord Imaging
- Congenital Spinal Abnormalities
Background:
- Dorsal lumbosacral lipomas (LSL) often have better prognoses than other conus lipomas.
- The integrity of the conus medullaris on MRI is hypothesized to influence LSL outcomes.
Purpose of the Study:
- To investigate the relationship between conus integrity on MRI and patient outcomes in dorsal LSL.
- To determine if conus visualization on MRI predicts favorable neuro-urological and motor status.
Main Methods:
- Retrospective review of 26 children with dorsal LSL (Morota type 1).
- Inclusion criteria: asymptomatic, age >3 years, neurological/urological evaluation.
- Outcomes assessed: need for untethering surgery, neuro-urological status, motor function.
Main Results:
- 92% had low conus level (≤L2).
- Nine children (35%) required surgery; 5 prophylactic, 4 due to deterioration.
- Excellent continence (25/26), one with stress incontinence; no catheterization needed. One had residual ankle weakness.
Conclusions:
- Conus visualization on MRI correlates with good neuro-urological and motor outcomes in LSL.
- Conus integrity is a more significant prognostic factor than anatomical level.
- Observational management is viable, supporting a selective surgical approach for dorsal LSL.
