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



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.


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).


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.


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.


Occult spinal dysraphism Tethered cord syndrome Surgical outcome Prophylactic surgery 


Compliance with ethical standards

Conflict of interest

No conflict of interest for any author.


  1. 1.
    Tortori-Donati P, Rossi A, Cama A (2000) Spinal dysraphism: a review of neuroradiological features with embryological correlations and proposal for a new classification. Neuroradiology 42:471–491CrossRefPubMedGoogle Scholar
  2. 2.
    Brown E, Matthes JC, Bazan C 3rd, Jinkins JR (1994) Prevalence of incidental intraspinal lipoma of the lumbosacral spine as determined by MRI. Spine 19:833–836CrossRefPubMedGoogle Scholar
  3. 3.
    Uchino A, Mori T, Ohno M (1991) Thickened fatty filum terminale: MR imaging. Neuroradiology 33:331–333CrossRefPubMedGoogle Scholar
  4. 4.
    Okumura R, Minami S, Asato R, Konishi J (1990) Fatty filum terminale: assessment with MR imaging. J Comput Assist Tomogr 14:571–573CrossRefPubMedGoogle Scholar
  5. 5.
    Paik NC, Lim CS, Jang HS (2013) Numeric and morphological verification of lumbosacral segments in 8280 consecutive patients. Spine 38:E573–E578CrossRefPubMedGoogle Scholar
  6. 6.
    Kole MJ, Fridley JS, Jea A, Bollo RJ (2014) Currarino syndrome and spinal dysraphism. J Neurosurg Pediatr 13:685–689CrossRefPubMedGoogle Scholar
  7. 7.
    O’Neill BR, Yu AK, Tyler-Kabara EC (2010) Prevalence of tethered spinal cord in infants with VACTERL. J Neurosurg Pediatr 6:177–182CrossRefPubMedGoogle Scholar
  8. 8.
    Kuo MF, Tsai Y, Hsu WM, Chen RS, Tu YK, Wang HS (2007) Tethered spinal cord and VACTERL association. J Neurosurg 106:201–204PubMedGoogle Scholar
  9. 9.
    Golonka NR, Haga LJ, Keating RP, Eichelberger MR, Gilbert JC, Hartman GE, Powell DM, Vezina G, Newman KD (2002) Routine MRI evaluation of low imperforate anus reveals unexpected high incidence of tethered spinal cord. J Pediatr Surg 37:966–969 discussion 966-969CrossRefPubMedGoogle Scholar
  10. 10.
    Tuuha SE, Aziz D, Drake J, Wales P, Kim PC (2004) Is surgery necessary for asymptomatic tethered cord in anorectal malformation patients? J Pediatr Surg 39:773–777CrossRefPubMedGoogle Scholar
  11. 11.
    Kumar A, Kanojia RK, Saili A (2014) Skin dimples. Int J Dermatol 53:789–797CrossRefPubMedGoogle Scholar
  12. 12.
    Finn MA, Walker ML (2007) Spinal lipomas: clinical spectrum, embryology, and treatment. Neurosurg Focus 23:E10CrossRefPubMedGoogle Scholar
  13. 13.
    Pierre-Kahn A, Zerah M, Renier D, Cinalli G, Sainte-Rose C, Lellouch-Tubiana A, Brunelle F, Le Merrer M, Giudicelli Y, Pichon J, Kleinknecht B, Nataf F (1997) Congenital lumbosacral lipomas. Child Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 13:298–334 discussion 335CrossRefGoogle Scholar
  14. 14.
    McLendon RE, Oakes WJ, Heinz ER, Yeates AE, Burger PC (1988) Adipose tissue in the filum terminale: a computed tomographic finding that may indicate tethering of the spinal cord. Neurosurg 22:873–876CrossRefGoogle Scholar
  15. 15.
    Cools MJ, Al-Holou WN, Stetler WR Jr, Wilson TJ, Muraszko KM, Ibrahim M, La Marca F, Garton HJ, Maher CO (2014) Filum terminale lipomas: imaging prevalence, natural history, and conus position. J Neurosurg Pediatr 13:559–567CrossRefPubMedGoogle Scholar
  16. 16.
    Yong RL, Habrock-Bach T, Vaughan M, Kestle JR, Steinbok P (2011) Symptomatic retethering of the spinal cord after section of a tight filum terminale. Neurosurg 68:1594–1601 discussion 1601-1592CrossRefGoogle Scholar
  17. 17.
    Dorward NL, Scatliff JH, Hayward RD (2002) Congenital lumbosacral lipomas: pitfalls in analysing the results of prophylactic surgery. Child Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 18:326–332CrossRefGoogle Scholar
  18. 18.
    Vernet O, Farmer JP, Houle AM, Montes JL (1996) Impact of urodynamic studies on the surgical management of spinal cord tethering. J Neurosurg 85:555–559CrossRefPubMedGoogle Scholar
  19. 19.
    Koyanagi I, Iwasaki Y, Hida K, Abe H, Isu T, Akino M, Aida T (2000) Factors in neurological deterioration and role of surgical treatment in lumbosacral spinal lipoma. Child Nerv Syst: ChNS: Off J Int Soc Pediatr Neurosurg 16:143–149CrossRefGoogle Scholar
  20. 20.
    Bulsara KR, Zomorodi AR, Enterline DS, George TM (2004) The value of magnetic resonance imaging in the evaluation of fatty filum terminale. Neurosurg 54:375–379 discussion 379-380CrossRefGoogle Scholar
  21. 21.
    Warder DE, Oakes WJ (1993) Tethered cord syndrome and the conus in a normal position. Neurosurgery 33:374–378CrossRefPubMedGoogle Scholar
  22. 22.
    Steinbok P, Kariyattil R, MacNeily AE (2007) Comparison of section of filum terminale and non-neurosurgical management for urinary incontinence in patients with normal conus position and possible occult tethered cord syndrome. Neurosurg 61:550–555 discussion 555-556CrossRefGoogle Scholar
  23. 23.
    Fabiano AJ, Khan MF, Rozzelle CJ, Li V (2009) Preoperative predictors for improvement after surgical untethering in occult tight filum terminale syndrome. Pediatr Neurosurg 45:256–261CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Ostling LR, Bierbrauer KS, Kuntz C (2012) Outcome, reoperation, and complications in 99 consecutive children operated for tight or fatty filum. World neurosurgery 77:187–191CrossRefPubMedGoogle Scholar
  25. 25.
    Ogiwara H, Lyszczarz A, Alden TD, Bowman RM, McLone DG, Tomita T (2011) Retethering of transected fatty filum terminales. J Neurosurg Pediatr 7:42–46CrossRefPubMedGoogle Scholar
  26. 26.
    Pang D, Zovickian J, Oviedo A (2010) Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode, part II: outcome analysis and preoperative profiling. Neurosurg 66:253–272 discussion 272-253CrossRefGoogle Scholar
  27. 27.
    La Marca F, Grant JA, Tomita T, McLone DG (1997) Spinal lipomas in children: outcome of 270 procedures. Pediatr Neurosurg 26:8–16CrossRefPubMedGoogle Scholar
  28. 28.
    Kulkarni AV, Pierre-Kahn A, Zerah M (2004) Conservative management of asymptomatic spinal lipomas of the conus. Neurosurg 54:868–873 discussion 873-865CrossRefGoogle Scholar
  29. 29.
    Hoffman HJ, Hendrick EB, Humphreys RP (1976) The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Childs Brain 2:145–155PubMedGoogle Scholar
  30. 30.
    Drake JM (2006) Occult tethered cord syndrome: not an indication for surgery. J Neurosurg 104:305–308CrossRefPubMedGoogle Scholar

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

Personalised recommendations