Spinal cord lipoma

Spinal cord lipoma is a rare congenital malformation in which a benign fatty mass (lipoma) is located within or adjacent to the spinal cord, most commonly in the lumbosacral region. It is classified as a form of occult spinal dysraphism (closed neural tube defect), meaning the overlying skin is typically intact, though a subcutaneous fatty mass, skin dimple, dermal sinus, or hairy patch may be visible over the lower back. The lipoma is attached to or integrated into the spinal cord and its coverings, and it can cause tethering of the spinal cord, restricting its normal movement within the spinal canal. The condition primarily affects the nervous system and musculoskeletal system. Key clinical features result from spinal cord tethering and compression and may include progressive lower limb weakness, gait abnormalities, sensory changes in the legs and perineum, lower back or leg pain, foot deformities (such as clubfoot or cavus foot), scoliosis, and neurogenic bladder and bowel dysfunction (urinary incontinence, constipation, or fecal incontinence). Symptoms may be present from birth or may develop insidiously during childhood as the child grows and the tethered cord is subjected to increasing traction. Some patients remain asymptomatic and are diagnosed incidentally. Diagnosis is typically made through magnetic resonance imaging (MRI) of the spine, which can delineate the lipoma and its relationship to the spinal cord. Management is primarily surgical, involving neurosurgical untethering of the spinal cord and debulking of the lipoma to prevent or halt neurological deterioration. The decision to operate on asymptomatic patients remains a subject of clinical debate, as surgery carries risks including re-tethering. Conservative management with close clinical and urological monitoring may be appropriate in selected cases. Early detection and multidisciplinary follow-up involving neurosurgery, urology, and rehabilitation are important for optimizing outcomes.

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