LIPOMAS AND LIPOMYELOMENINGOCELES
There are many forms of Spina Bifida, the one which our daughter has is called a lipomyelomeningocele.
Lipoma and Lipomyelomeningocele (tethered cord) means that with normal growth the cord cannot ascend as normal so the cord comes under tension.
What is a lipomyelomeningocele?
This is a congenital lesion that is associated with Spina Bifida (congenital failure of closure of the spinal bones). This is associated with abnormal fat accumulation that starts below the level of the skin and extends through the bony opening to the spinal cord.
The lesion itself is usually found in the lumbosacral region (lower back).
What is a spinal cord lipoma?
A spinal cord lipoma is a fatty mass or tumour within the spinal cord. It often occurs in a normally positioned cord without any skin or bone abnormalities.
What are the symptoms of spinal cord lipomas?
Evidence of numbness, tingling, weakness, difficulty with urinating or with bowel movements, incontinence, and spasticity (stiffness) of the extremities.
More than 90% of patients will also have a soft tissue swelling over the spine, these lesions are covered by skin and not usually painful.
Patients may loose neurological function quickly after birth, but more typically deteriation is over a period of months to years.
Who gets Lipomyelomeningocele?
It usually affects females more than males in a 1.5 to 1 ratio, and it becomes evident in the first few months of life.
How are spinal cord lipomas treated?
The point of surgical treatment is to prevent any further damage and may not rectify present condition.
A laminectomy is performed to gain opening to the spinal cord. The goal of the procedure is not the total removal of the fat but rather the substantial debulking of the lipoma. No other treatment method is recommended.
An MRI has become the procedure of choice to diagnose the condition, and will also help the surgeon plan the operation procedure.
The outcome of such an operation is that 19% will improve 75% unchange condition and 6% will worsen.
Since symptoms are due to :
- Tethering of the Spinal cord, especially during growth spurts and
- Compression due to progressive deposition of fat.
Simple cosmetic treatment of the subcutaneous fat pad does NOT prevent Neurological deficit, and may make later definitive treatment more difficult.
