Outcomes of Therapies for Spinal Lipoma in Children

Outcome After Surgery

Generalities About Surgical Outcomes

• Goal is prevention of new symptoms: The main goal of surgery for spinal lipomas is to prevent new symptoms in those having preventative surgery and stop the worsening of symptoms in patients already showing signs (34).
• In general, preventative surgery is only performed if total or near-total resection is possible: Preventive surgery is recommended if the surgical approach would be total/near-total resection.
• Prophylactic resection of asymptomatic chaotic lipomas is not recommended: The notable exception is the asymptomatic chaotic lipoma, because its anatomical relationship with the neural tissue defies an aggressive surgical approach and resection results in worse outcomes than that achieved for other lipoma subtypes. Therefore, prophylactic resection of asymptomatic chaotic lipomas is not currently endorsed (35).
• Patients often report less pain: Patients who had pain before surgery, especially sharp pain in the legs and perineal area, often report improvements.
• Motor and sensory function often improves: Full return of motor skills in patients with an established preoperative deficit is rare (found in less than 20% of patients), but many see a notable improvement in motor and sensory functions (10).
• Bladder control may improve: Bladder control can improve after surgery, with 20% to 30% of patients experiencing positive changes (10). Nonetheless, of those children selected for radical resection of lipoma, approximately a third will require long-term catheterization.
• Long-term renal damage due to neuropathic bladder is rare.

Short-Term Outcomes After Partial Resection

The majority — approximately 95% — of symptomatic patients receiving partial lipoma resection benefited, at least in the short term (10). The early postoperative statuses were reported as follows (10):

• 6.9% became normal in all aspects.
• 15.5% improved in all symptom categories.
• 12% improved in some categories.
• 60% were stabilized by the operation.
• Approximately 5% had worsened neurologic status from surgery.

Long-Term Outcomes After Partial Resection

Over a 6-year mean follow-up period, the outcome for symptomatic patients following partial resection was as follows (10):

• About half experienced deterioration: The deterioration rate for patients with partial resection of the lipoma was 53.4% over a 6-year mean follow-up period.
• About a third reported lasting improvements: 38% of the patients with preoperative motor weakness improved after surgery, and 30% experienced improved urological outcome.
• Some conditions were not alleviated: None of the patients with fecal incontinence or neurogenic megacolon improved, and there were no changes in the spinal and foot alignments.

Short-Term Outcomes After Total/Near-Total Resection

The majority — approximately 94% — of symptomatic patients receiving total or near-total lipoma resection benefited, at least in the short term (10). The early postoperative statuses were reported as follows (10):

• 13% became normal in all aspects.
• 11% improved in all symptom categories.
• 37% improved in at least one category.
• 33% were stabilized by the operation.
• 5.9% were made worse by the operation, mostly because of dysesthetic pain (not neurological deficit).

Long-Term Outcomes After Total/Near-Total Resection

Over a mean follow-up period of 7 years, the outcome for symptomatic patients following total or near-total resection was as follows (10):

• One in 10 required a second surgery: 10% deteriorated during the follow-up and required a second surgery.
• Dysesthetic pain alleviated in the vast majority: Of all symptoms, dysesthetic pain responded the best to surgery, abating completely in 75% of patients and partially but significantly in 7% of patients.
• Motor deficits improved in most: Motor deficits improved in 58% of the patients, but only 6% exhibited normal motor functioning.
• Urological function improved in a third: Urological outcome improved in 33% of patients.

Outcome After Nonsurgical Treatments

Approximately one- to two-thirds experience deterioration: Patients with asymptomatic lipomas have a 33% to 60% chance of their conditions deteriorating over 10 years (2,25,26). Forgoing surgery can lead to increasing nerve-related problems, such as weakness, reduced sensation, and problems with bowel or bladder control.

Outcome After Multimodal Therapies

• No alternative treatments available: The only options for the treatment of spinal lipomas are surgical resection (partial or total) or conservative management with follow-up.