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

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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.

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  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 42:471–491

    Article  CAS  PubMed  Google Scholar 

  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 19:833–836

    Article  CAS  PubMed  Google Scholar 

  3. Uchino A, Mori T, Ohno M (1991) Thickened fatty filum terminale: MR imaging. Neuroradiology 33:331–333

    Article  CAS  PubMed  Google Scholar 

  4. Okumura R, Minami S, Asato R, Konishi J (1990) Fatty filum terminale: assessment with MR imaging. J Comput Assist Tomogr 14:571–573

    Article  CAS  PubMed  Google Scholar 

  5. Paik NC, Lim CS, Jang HS (2013) Numeric and morphological verification of lumbosacral segments in 8280 consecutive patients. Spine 38:E573–E578

    Article  PubMed  Google Scholar 

  6. Kole MJ, Fridley JS, Jea A, Bollo RJ (2014) Currarino syndrome and spinal dysraphism. J Neurosurg Pediatr 13:685–689

    Article  PubMed  Google Scholar 

  7. O’Neill BR, Yu AK, Tyler-Kabara EC (2010) Prevalence of tethered spinal cord in infants with VACTERL. J Neurosurg Pediatr 6:177–182

    Article  PubMed  Google Scholar 

  8. Kuo MF, Tsai Y, Hsu WM, Chen RS, Tu YK, Wang HS (2007) Tethered spinal cord and VACTERL association. J Neurosurg 106:201–204

    PubMed  Google Scholar 

  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 966-969

    Article  PubMed  Google Scholar 

  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 39:773–777

    Article  PubMed  Google Scholar 

  11. Kumar A, Kanojia RK, Saili A (2014) Skin dimples. Int J Dermatol 53:789–797

    Article  PubMed  Google Scholar 

  12. Finn MA, Walker ML (2007) Spinal lipomas: clinical spectrum, embryology, and treatment. Neurosurg Focus 23:E10

    Article  PubMed  Google Scholar 

  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 335

    Article  CAS  Google Scholar 

  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 22:873–876

    Article  CAS  Google Scholar 

  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 13:559–567

    Article  PubMed  Google Scholar 

  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 1601-1592

    Article  Google Scholar 

  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 18:326–332

    Article  Google Scholar 

  18. Vernet O, Farmer JP, Houle AM, Montes JL (1996) Impact of urodynamic studies on the surgical management of spinal cord tethering. J Neurosurg 85:555–559

    Article  CAS  PubMed  Google Scholar 

  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 16:143–149

    Article  CAS  Google Scholar 

  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 379-380

    Article  Google Scholar 

  21. Warder DE, Oakes WJ (1993) Tethered cord syndrome and the conus in a normal position. Neurosurgery 33:374–378

    Article  CAS  PubMed  Google Scholar 

  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 555-556

    Article  Google Scholar 

  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 45:256–261

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ostling LR, Bierbrauer KS, Kuntz C (2012) Outcome, reoperation, and complications in 99 consecutive children operated for tight or fatty filum. World neurosurgery 77:187–191

    Article  PubMed  Google Scholar 

  25. Ogiwara H, Lyszczarz A, Alden TD, Bowman RM, McLone DG, Tomita T (2011) Retethering of transected fatty filum terminales. J Neurosurg Pediatr 7:42–46

    Article  PubMed  Google Scholar 

  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 272-253

    Article  Google Scholar 

  27. La Marca F, Grant JA, Tomita T, McLone DG (1997) Spinal lipomas in children: outcome of 270 procedures. Pediatr Neurosurg 26:8–16

    Article  PubMed  Google Scholar 

  28. Kulkarni AV, Pierre-Kahn A, Zerah M (2004) Conservative management of asymptomatic spinal lipomas of the conus. Neurosurg 54:868–873 discussion 873-865

    Article  Google Scholar 

  29. Hoffman HJ, Hendrick EB, Humphreys RP (1976) The tethered spinal cord: its protean manifestations, diagnosis and surgical correction. Childs Brain 2:145–155

    CAS  PubMed  Google Scholar 

  30. Drake JM (2006) Occult tethered cord syndrome: not an indication for surgery. J Neurosurg 104:305–308

    Article  PubMed  Google Scholar 

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Correspondence to Michel Zerah.

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Usami, K., Lallemant, P., Roujeau, T. et al. Spinal lipoma of the filum terminale: review of 174 consecutive patients. Childs Nerv Syst 32, 1265–1272 (2016).

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