178 A Comparison of Prophylactic and Symptomatic Detethering of Patients With Lumbosacral Lipomas in a Modern Era. Issue Volume 61:Issue CN Supp. 1(2014)Supplement (1st August 2014)

• Record Type: Journal Article
• Authors: Tu, Albert; Hengel, Ross; Cochrane, Douglas
• Is Part Of: Neurosurgery. Volume 61:Issue CN Supp. 1(2014)Supplement
• Page Start: 218
• Page End: 219
• Publication Date: 2014-08-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/01.neu.0000452452.35302.31
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Lumbosacral lipomas are the most common spinal dysraphism treated at the BC Children's Hospital (BCCH). Although patients may present asymptomatic, many deteriorate over time (1-4). Previous management included prophylactic detethering; however, recent studies have found deterioration rates similar to non-operated patients (1-4). At the BCCH Spina Bifida clinic, we present this information to families and offer 2 options: 1) untethering prior to the development of deficits or 2) close follow-up and intervene when the patient becomes symptomatic. While prior series have compared patients from different periods or using historical data, few exist with patients managed concurrently. METHODS: A retrospective review of lumbosacral lipomas seen at BCCH in a modern era (ie, last 20 years) was carried out. Only patients having been detethered were included. Patients with incomplete records were excluded, as were patients with filum lipomas. RESULTS: Thirty-three patients were identified. Twenty-two were detethered after becoming symptomatic, while 11 underwent prophylactic surgery. Symptomatic patients were detethered after 38.8 months, while prophylactic patients were detethered at 6.3 months ( P = .01). Prophylactic and symptomatic patients were detethered 1.27 and 1.22 times ( P = .41). Retethering occurred at 45.9 and 46.9 months ( P = .49) after initial surgery; however, prophylactic patients were 51.7 months of age at the time of retethering while conservative patients were 104.5 months ( P = .026). Prophylactic patients trended towards fewer complications (0.36 vs 0.73, P = .11). Outcomes were identical in both groups with 91% ( P = .5) remaining stable or improving at their final follow-up. CONCLUSION: Prophylactic or delayed detethering of patients produces no difference in long-term outcome. Prophylactic detethering had a similar incidence of retethering, although this occurred at a younger age. Given the increased challenges of surgery in younger children, delaying initial surgery may reduce the risk at subsequent detethering procedures.