Laser resection of fifty spinal lipomas.

The value of laser resection was assessed in the last 50 of 128 consecutive cases of pediatric spinal lipoma. In this series, there was no mortality. No patient suffered increase in neurological or urological deficit. Postoperatively, 8 of 20 patients with prior motor deficit (40%) had substantially improved motor function. Two of 17 previously incontinent patients became continent of urine (12%). Use of the CO2 laser reduced the length of operation, the intraoperative blood loss, and the degree of manipulation of the spinal cord and nerve roots. Most of the fat could be removed successfully from the liponeural junction, permitting more nearly anatomical removal of the intramedullary component of the lesion and greater ease in replacing the cord into a reconstructed arachnoid-dural canal. In the authors' opinions, proper management of the patient with spinal lipoma now requires early prophylactic resection of the lipoma and untethering of the spinal cord.