Pediatric Spinal Lipomas: A Narrative Review and Tertiary Center Experience
Chandrashekhar Gendle, Madhivanan Karthigeyan, Sivashanmugam DhandapaniBackground:
Spinal lipoma is a congenital dysraphic malformation that causes progressive neurological deterioration through tethered cord syndrome. The spectrum extends from simple filar lipoma to complex lipomyelomeningocele (LipoMMC), each with distinct embryology, anatomy, and prognosis.
Objectives:
To review the embryopathogenesis, classification, clinical presentation, surgical strategies, and outcomes of pediatric spinal lipoma, integrating published literature with institutional experience.
Material and Methods:
A narrative synthesis of the literature and a descriptive analysis of 71 consecutively operated children for spinal lipomas were performed. Lipomas were classified by the Arai and Morota frameworks; functional outcomes were graded as improved, static, or worse.
Results:
An overview of the salient published literature of pediatric spinal lipoma has been discussed along with our own patient series. The institutional cohort comprised LipoMMC (30%), caudal (25%), transitional (20%), dorsal (15%), and filar (10%) lipomas. Complete excision was achieved in 74.6%; incomplete resection (25.3%) reflected complex subtypes where radical removal was unsafe. Functional improvement occurred in 53.5%, stabilization in 40.8%, deterioration in 4.2%, and one postoperative death (1.4%).
Conclusions:
Subtypetailored surgery is essential for children with spinal lipomas. Early intervention in symptomatic patients and carefully selected asymptomatic infants yields the best neurological and urological outcomes. Total or near-total resection with neural placode reconstruction and expansile duraplasty reduces re-tethering and improves progression-free survival.