OPERATIVE RESECTION OF 100 SPINAL LIPOMAS IN INFANTS LESS-THAN 1 YEAROF AGE

A retrospective analysis of 100 children followed at Children's Memori al Hospital, Chicago, who underwent surgery for a spinal lipoma was pe rformed. The mean follow-up was 5 years. We found that an operation pe rformed during the Ist year of life with the goal of untethering the s pinal cord and debulking the spinal lipoma was safe and effective, whe reas a cosmetic (nonuntethering) procedure always led to delayed posto perative deterioration (symptomatic tethered cord). Of the infants tha t presented with motor, urologic or orthopedic symptoms, 39% improved, 58% stabilized, while 3% worsened as a result of surgery. No asymptom atic infant deteriorated postoperatively and 93% of these children rem ained symptom-free at follow-up (mean follow-up was 44 months). The ov erall outcome of infants after untethering procedures in this study wa s significantly better than the natural history of spinal lipomas. Sev eral risk factors were identified that may predispose children to dela yed postoperative deterioration: an initial cosmetic procedure; the pr esence of preoperative symptoms, and the presence of a lipomyelomening ocele.