Follow-up for Spinal Lipoma in Children

Frequency of Office Visits

Precontinent Children

For precontinent children, follow-up is every 6 months until continence is established.

Continent Children

It is essential to monitor recovery and assess neurological symptoms after spine surgery through postoperative appointments. The suggested timetable for these postoperative visits is:

• Day 10: The patient should consult with the neurosurgeon or a specialized nurse to assess the status of wound healing.
• 3 months: Neurological assessment and repeat muscle charting, follow-up bladder function assessment, and MRI scan of lumbosacral spine.
• 6 months: Repeat motor assessment and evaluation of sphincter function, with repeat urological studies if concerns are noted.
• 1 year: Annual review comprises neurological and urological assessment. Routine MRI scans are not indicated.

Frequency of Imaging

• Lumbosacral spine MRI at 3-6 months: A follow-up MRI of the lumbosacral spine is recommended at 3 to 6 months postoperatively to assess cord-sac ratio (and thus risk of retethering), the extent of lipoma resection, and any adverse postsurgical changes (e.g., pseudomeningocele or new syrinx). Said imaging will also provide a baseline for comparison in the event of future deterioration.
• Absent new clinical concern, repeat MRIs are not required.
• Cord-sac ratio linked to retethering risk: Patients with cord-sac ratios <30% have less likelihood of retethering, compared with patients with a ratio between 30% and 50%. Patients with ratios >50% have the highest reoperation rate (10).

Cord-sac radio: An axial slice of a spine MRI in which the cord-sac radio is calculated. The ratio is obtained by dividing the sagittal diameter of the reconstructed cord (labeled “A”) by the sagittal diameter of the expanded thecal sac (labeled “B”).

Other Investigations Required

Following a spinal lipoma resection, ongoing urological assessment is mandatory. The principles of urological follow-up include:

• Ensure safety of the renal tract: Assess the adequacy of bladder emptying and check for urinary infection or vesicoureteral reflux.
• Optimize continence: Where necessary, use medication and catheterization.
• Monitor for retethering: Identify new changes that might signify the onset of retethering.