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Child's Nervous System

, Volume 32, Issue 7, pp 1265–1272 | Cite as

Spinal lipoma of the filum terminale: review of 174 consecutive patients

  • Kenichi Usami
  • Pauline Lallemant
  • Thomas Roujeau
  • Syril James
  • Kevin Beccaria
  • Raphael Levy
  • Federico Di Rocco
  • Christian Sainte-Rose
  • Michel ZerahEmail author
Original Paper

Abstract

Purpose

Spinal lipoma of the filum terminale (LFT) is a congenital lumbosacral anomaly that can cause tethered cord syndrome. Purposes of this study are to clarify preoperative characteristics of LFT, to elucidate surgical effects, and to discuss the rationale of prophylactic surgery for LFT.

Methods

Medical data of 174 children (2008–2014) who underwent section of LFT were prospectively recorded for prevalence of symptoms, skin stigmas, and associated malformations, motivator of diagnosis, conus level, and surgical outcome. Mean age at surgery was 4.1 ± 4.2 years (37 days to 17.7 years).

Results

Ninety-four children (54.0 %) had skin stigmas and 60 (34.5 %) had certain perineal malformations. Seventy-nine children (45.4 %) were symptomatic. The most common motivator for diagnosis was skin stigmas (44.3 %), followed by associated malformations (33.3 %), and symptoms (20.1 %). The age at surgery was significantly older in symptomatic patients than in asymptomatic patients (p < 0.001). Surgery improved symptoms in 50 % of patients at 2.1-year follow-up period. Of 85 asymptomatic patients, all except one remained asymptomatic postoperatively and none of the symptomatic patients deteriorated. The presence of associated malformations and the conus level did not affect surgical outcome. Postoperative complications developed in nine patients (5.2 %): seven transient local problems, one definitive urological deterioration, and one transient respiratory problem.

Conclusions

Surgery for LFT was a simple and safe procedure. It improved half of symptomatic patients and stopped the deterioration of the others. Even if only one of the asymptomatic patients deteriorated at maximum follow-up, the role of prophylactic surgery remains a point of discussion.

Keywords

Occult spinal dysraphism Tethered cord syndrome Surgical outcome Prophylactic surgery 

Notes

Compliance with ethical standards

Conflict of interest

No conflict of interest for any author.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Kenichi Usami
    • 1
  • Pauline Lallemant
    • 2
  • Thomas Roujeau
    • 1
  • Syril James
    • 1
  • Kevin Beccaria
    • 1
  • Raphael Levy
    • 3
  • Federico Di Rocco
    • 1
  • Christian Sainte-Rose
    • 1
  • Michel Zerah
    • 1
    Email author
  1. 1.Department of Pediatric NeurosurgeryNecker-Enfants Malades Hospital, Assistance Publique Hopitaux de Paris, Paris V UniversityParisFrance
  2. 2.Department of Pediatric RehabilitationTrousseau HospitalParisFrance
  3. 3.Department of Pediatric RadiologyNecker-Enfants Malades HospitalParisFrance

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