Operative resection of 100 spinal lipomas in infants less than 1 year of age.

A retrospective analysis of 100 children followed at Children's Memorial Hospital, Chicago, who underwent surgery for a spinal lipoma was performed. The mean follow-up was 5 years. We found that an operation performed during the 1st year of life with the goal of untethering the spinal cord and debulking the spinal lipoma was safe and effective, whereas a cosmetic (nonuntethering) procedure always led to delayed postoperative deterioration (symptomatic tethered cord). Of the infants that presented with motor, urologic or orthopedic symptoms, 39% improved, 58% stabilized, while 3% worsened as a result of surgery. No asymptomatic infant deteriorated postoperatively and 93% of these children remained symptom-free at follow-up (mean follow-up was 44 months). The overall outcome of infants after untethering procedures in this study was significantly better than the natural history of spinal lipomas. Several risk factors were identified that may predispose children to delayed postoperative deterioration: an initial cosmetic procedure; the presence of preoperative symptoms, and the presence of a lipomyelomeningocele.