Anatomo-Radiological Patterns of Tethered Spinal Cord With Lipoma

Background & Aim: Tethered spinal cord is the most prevalent anatomical deformity, usually diagnosed in childhood. The present study aimed to describe the different anatomo-radiological patterns of the tethered spinal cord with lipoma. Methods & Materials/Patients: We conducted a retrospective descriptive study in the Neurosurgery Department of General Grand Yoff Hospital and the Neurosurgical Clinic in the Fann University Hospital of Dakar City, Senegal. Eight patients with spinal lipoma underwent operation in these medical centers from July 2007 to January 2011. The anatomo-radiological and clinical data of patients were collected and analyzed. Results: The mean age of patients was 4 years old, ranging from 45 days to 30 years. The patients’ male to female ratio was 0.6. The symptomatic triad of median[A1]  cutaneous signs, orthopedic and sphincter disorders were detected in two (25%) patients. Neuroimaging (mainly MRI) revealed conus medullaris lipoma in 7 (87.5%) cases, and a filum terminale lipoma in one (12.5%) case. All of the patients had a tethered spinal cord with a low-lying conus medullaris. The dehiscence of posterior lumbosacral and sacral vertebral arches were noted in 7 (87.5%) cases, and scoliosis (1 case) and scalloping (1 case) were observed, as well. All patients were operated and the surgical outcome was desirable for 5 (62.5%) of them. No death has been observed. According to the surgical findings, the patients were classified into modified Chapman classification. Conclusion: In comparison to myelomeningocele, tethered spinal cord with lipoma is rarely observed. Health practitioners should consider this condition in the management of children or young adult patients with median lumbar sacral cutaneous associated or not associated with lower limb orthopedic abnormalities or sphincter disorders. Ultrasound and MRI are appropriate diagnostic tools for the proper surgical planning of newborns. However, MRI is reportedly more sensitive and the surgical option for asymptomatic cases remains controversial. In our experience, the surgical findings can provide comprehensive data on the interface between the lipoma and the neural structure.