Factors in neurological deterioration and role of surgical treatment in lumbosacral spinal lipoma

The purpose of this study was to determine factors that might be involved i n neurological deterioration and the role of surgical treatment in patients with lumbosacral spinal lipoma. Pre- and postoperative courses of 34 patie nts were retrospectively analyzed. The age at surgery ranged from 1 month t o 47 years. The records of preoperative neurological status indicated that older patients had more severe deficits, while all 8 asymptomatic patients were under 5 years of age. Motor deficits were noted in 9 patients, in 7 of whom the lipoma extended cranially beyond the L5 level. Transitional-type lipomas were accompanied by more severe deficits (asymptomatic 1, symptomat ic 17) than other types (asymptomatic 7, symptomatic 9). Postoperative foll ow-up periods ranged from 5 months to 13 years. During these periods, 7 of the 8 asymptomatic patients remained neurologically intact. Nine of the 26 symptomatic patients improved. Age, extension of the lipoma in the spinal. canal and type of lipoma will influence the preoperative neurological statu s of the patients. Early untethering surgery is recommended in patients wit h large lipomas extending beyond the L5 level.