Lipomyelomeningocele
What is it?
Lipomyelomeningocele is one of the several common forms of occult (hard to detect) spinal dysraphism (a congenital abnormality that results in an abnormal structure in the spine) in which an abnormal growth of fat attaches to the spinal cord and its membranes. Normally, the spinal cord is able to move relatively freely within the spinal canal. However, in this condition, the cord’s movement is restricted by the connection with the meninges and the area outside the spinal canal.
Symptoms
The symptoms can be very variable and depend largely on the age of the patient. Young children often present with an obvious abnormality on the skin, which can include changes in the color of the skin, hairy patches or masses. Patients can have trouble with their bladder and urinary tract, problems with their legs, or curved spine (scoliosis). Adult patients present with other changes such as lower back pain, changes in sensation and a changed walking pattern. Some patients may not have any of these symptoms for many years, and in some cases may not ever have symptoms.
Diagnosis
Today is possible to diagnose myelomeningocele even in utero. More often it is diagnosed at birth by the presence of a pad of fat over the lower spine. In infants with signs of lipomyelomeningocele, spinal ultrasound, and Magnetic Resonance (MR) imaging can allow doctors to make a specific diagnosis.
Treatment
Surgical treatment aims to improve or stabilize symptoms in symptomatic patients and prevent future problems in asymptomatic patients. During surgery for lipomyelomeningocele, spine surgeon will free the spinal cord from its attachment to the lipoma, remove as much of the lipoma as safely possible, and close the membranes over the spinal cord. There are no guidelines for the timing of surgery. Most doctors believe that early surgery offers improved outcomes compared to how the condition would progress naturally. In some cases, it may be better to wait and watch carefully, performing surgery only if symptoms appear.