Management of Spinal Lipoma in Children

Initial Management at Presentation

Following the initial assessment, and after balancing the risk and benefits of treatment, there are two management options:

• Observation: Conservative management has been decided and the child has been assigned to follow-up.
• Surgery: The child will undergo lipoma resection and detethering.

Adjunctive Therapies

• None: None are typically required.

Follow-up

The following is a suggested follow-up paradigm for children with lumbosacral lipoma.

Observational management

For children on nonoperative pathway:

• Precontinent children: Precontinent children should be assessed at 6-month intervals until continence is established or there is a new decision to operate. Follow-up consists of both a clinical assessment of neurodevelopmental progress and motor function (including muscle charting), and a urological assessment, including evaluation of efficacy of bladder emptying.
• Continent children: Once continence is achieved (and for children that have established continence), follow-up can be reduced to an annual basis.
• Clinical and MRI evaluation: Clinical evaluation is the most important means of follow-up. Routine follow-up MRI evaluations are not indicated unless there are specific concerns (e.g., enlarging syrinx).

Postsurgical management

Children who have undergone surgery should receive follow-up on the following schedule:

• 2 weeks after surgery: A wound check is necessary to assess wound healing, evidence of infection, CSF leak, or pseudomeningocele formation. Also, a postmicturition ultrasound scan should be performed to evaluate bladder emptying.
• 3 months after surgery: A clinical re-evaluation with muscle examination and urological reassessment is required. Include an MRI of the lumbosacral spine to assess the extent of lipoma resection, measure cord-sac ratio (as this has prognostic significance), and provide a baseline for future comparison.