Distal spinal cord pathology in the VATER association

Herein the authors report the pathology of six cases of VATER association and tethered spinal cord that underwent operative intervention for removal of lipomas of the conusfilum terminale and/or release of the tethered cord. In five of the six patients, the excised filum terminale consistently showed excessive mature adipose tissue, normal blood vessels, small myelinated nerve fibers, and fibrous connective tissue. One patient had mature lobulated adipose tissue and vessels only. It is concluded that patients with the VATER association who present with distal spinal cord pathology consistently have abnormal involution of the filum terminale, the hallmark being an abnormal collection of mature fat, thickening of the filum, and extension of the fat into the conus medullaris.