Our Summary

This research paper investigates the treatment of a condition known as congenital intraspinal lipomas in adults. These are fatty lumps that form inside the spinal cord at birth. The study specifically looks at what happens when these lipomas are almost completely or completely removed through surgery.

The researchers examined the medical records of 122 adult patients who had this surgery. They divided the patients into three groups based on when symptoms first appeared: those who showed symptoms at or before the age of 5, those who showed symptoms between the ages of 5 and 18, and those who showed symptoms after turning 18.

The most common symptoms were bladder problems and constipation. Three months after the surgery, most patients who had experienced pain or skin ulcers caused by nerve damage reported improvements. Overall, 73% of patients experienced improved neurological health after the surgery, while nearly 20% saw their condition stabilize.

The study identified two factors that predicted improvement after surgery: having symptoms for a shorter time before the operation and experiencing pain before the operation. Some patients experienced complications related to the neurosurgery and wound healing. A few patients had recurring symptoms and required further surgery.

The study concludes that even though adult patients live with these lipomas for a longer time before treatment compared to children, they still benefit from having them almost or completely removed, especially in terms of pain relief and healing of nerve damage-related ulcers. The study also raises the question of whether removing additional lipoma in adults provides long-term benefits.

FAQs

  1. What are the most common symptoms of congenital intraspinal lipomas?
  2. What factors were identified as independent predictors of postoperative improvement in patients with congenital intraspinal lipomas?
  3. What are the potential complications of total/near-total resection surgery for lumbosacral lipomas?

Doctor’s Tip

One helpful tip a doctor might tell a patient about detethering surgery is to ensure they follow postoperative instructions carefully, including proper wound care and physical therapy exercises to optimize their recovery and reduce the risk of complications. It is also important for patients to attend follow-up appointments to monitor their progress and address any concerns promptly.

Suitable For

Adult patients with congenital lumbosacral lipomas who are experiencing symptoms such as bladder dysfunction, constipation, pain, neuropathic ulcers, and neurologic deficits are typically recommended for detethering surgery. In this study, patients with symptom onset at a younger age were found to have better postoperative outcomes, but even adult patients can benefit from total or near-total resection of the lipoma. Patients with shorter preoperative duration and preoperative pain were more likely to experience postoperative improvement in neurologic status. Surgery-related complications were relatively low, and some patients may require repeated detethering surgery in the long-term follow-up.

Timeline

  • Pre-surgery: Patients experience symptoms such as bladder dysfunction, constipation, pain, and neuropathic ulcers. They undergo preoperative evaluations and consultations with neurosurgeons to determine the need for detethering surgery.
  • Day of surgery: Patients undergo detethering surgery to remove the lipoma causing the tethered cord syndrome.
  • Post-surgery: Patients experience improvement in symptoms such as pain and neuropathic ulcers at the 3-month follow-up. Overall, their neurologic status improves in 73.0% of cases and stabilizes in 19.7% of cases. Some patients may experience complications such as neurosurgical complications or wound complications.
  • Long-term follow-up: Patients may undergo repeated detethering surgery if symptoms recur. The long-term advantage of resecting additional lipoma in adults remains a point of discussion.

What to Ask Your Doctor

  1. What are the potential risks and benefits of detethering surgery for my specific case?
  2. How long is the recovery process expected to be after detethering surgery?
  3. What are the chances of my symptoms improving or worsening after the surgery?
  4. Are there any alternative treatments or therapies that I should consider before opting for detethering surgery?
  5. How experienced are you and your surgical team in performing detethering surgeries for adult patients with congenital intraspinal lipomas?
  6. What is the success rate of detethering surgery in adult patients with lumbosacral lipomas?
  7. Are there any specific lifestyle changes or post-operative care instructions that I should follow after the surgery?
  8. How frequently will I need to follow up with you after the surgery for monitoring and evaluation of my progress?
  9. Are there any potential long-term complications or risks associated with detethering surgery that I should be aware of?
  10. Can you provide me with any patient testimonials or case studies of adult patients who have undergone detethering surgery for lumbosacral lipomas?

Reference

Authors: Bai SC, Tao BZ, Wang LK, Yu XG, Xu BN, Shang AJ. Journal: World Neurosurg. 2018 Apr;112:e331-e341. doi: 10.1016/j.wneu.2018.01.044. Epub 2018 Jan 11. PMID: 29337168