Results after surgery for lumbosacral lipoma: the significance of early and late worsening

We retrospectively re viewed 32 patients operated on for lipoma of the conu s and lipomyeloschisis, the two main anatomical subtypes of congenital lumb osacral lipomas associated with tethered cord syndrome. Surgery was propose d to patients when they were symptomatic, and in most cases for progressive symptoms. The evolution of the different symptoms was studied separately. In most patients, symptoms improved or stabilized after surgery; in some, h owever, postoperative worsening, at least of some of the symptoms, was seen . This postoperative worsening became apparent either early or late after t he operation, and was not associated with surgical trauma or postoperative complications. We suggest it was caused mainly by the natural course of the disease (especially in the case of the orthopedic deformities), and in som e cases by retethering. Our series is not large enough to detect statistica l significance for the different symptoms or for the anatomical subgroups. Importantly, according to our analysis by the different symptoms, the opera tion did not seem to protect the patients from later development of new def icits. This can be interpreted as an argument against prophylactic surgery in asymptomatic patients.