Medical Student University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, United States
Introduction: Filum terminale lipomas are a congenital lumbosacral lesion that often require surgical detethering. Compression of the spinal cord by these lipomas can cause symptoms such as bladder dysfunction, back and leg pain, and weakness.
Methods: We conducted a retrospective analysis of 261 of filum terminale lipomas (FTL) patients that underwent surgery from 2010-2015. The study’s objective was to evaluate the incidence of these patients’ presentation with urologic symptoms and analyze outcomes. Pre- and post-operative urodynamic studies and cystemetrogram (CMG), when available, were used to assess indications and outcomes. We compared patients that presented with urologic symptoms (n=34) to those that did not (n=226).
Results: and their mean age at surgery was 7.04 years (SD = 4.39) and 50% male. Urologic symptoms at presentation included urinary incontinence or retention (97%), constipation (53%), and bowel incontinence (44%). About 32% of the patients were diagnosed with a neurogenic bladder. Urinary incontinence in patients that were previously incontinent improved 48%, constipation 50%, and bowel incontinence 60% of the time. Non-urologic symptoms at surgery included back pain (26%), leg pain (35%), paresthesias (21%), and abnormal gait (32%). Back pain improved 78%, leg pain improved 75%, paresthesia 43%, and abnormal gait 45% of the time. Average length of symptoms was 1.88 years (SD = 2.21 years). Neither male sex nor age at surgery was significantly associated with symptom improvement with tethered cord release surgery. Patients with urologic symptoms had surgery at a significantly older age (p < 0.001).
Conclusion : These findings indicate that while most FTL patients do not experience urological symptoms, those who do require surgery at an older age than asymptomatic FTL patients. Additionally, those with longstanding bowel and bladder incontinence can see improvement in their symptoms after de-tethering of their lipoma.
