Lipomas are benign growths that are made up of normal adipose tissue (i.e., fat cells). They may rarely arise in the spinal cord or in the filum terminale, the thin fibrous tissue that connects to the bottom of the spinal cord.
Lipomas are considered developmental or inclusion tumors because they are caused by an error in fetal development in which normal adipose tissue remains stuck to developing spinal cord tissue. Dermoids and epidermoids are also considered developmental inclusion tumors. Developmental tumors may be associated with other abnormalities such as birthmarks, a hairy skin patch, or skin dimples near the level of the developmental tumor. Abnormalities of the vertebrae may also occur, a condition called spina bifida occulta. Because these conditions are associated with abnormal development they are referred to as dysraphic conditions.
In many patients, lipomas do not produce symptoms and no treatment is needed. Treatment may be indicated, however, if symptoms are present. Weakness and numbness in the legs may lead to walking difficulties as well as bowel and bladder problems. These symptoms can be caused either by pressure of the lipoma on the spinal cord or by excess tension on the spinal cord, a so-called tethered spinal cord.
Tests and Diagnosis
MRI is the most useful imaging study for diagnosing a lipoma. CAT scan may also show the lipoma, and it will also identify any developmental abnormalities of the vertebrae.
Treatment of symptomatic spinal lipomas consists of microsurgical removal of the lipoma. In cases where there is tethering of the spinal cord, usually from lipomas of the filum terminale, a release of the tension is achieved by removing all the attachments and releasing the filum terminale. A video of a successful micro-neurosurgical removal of a spinal lipoma by Dr. Paul McCormick is provided below.
Preparing for Your Appointment
At The Spine Hospital, our spinal neurosurgeons are experts in the evaluation and management of patients with Lipoma/ Lipo Myelominingiocele (pediatric term).