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 two 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: 33 patients were identified. 22 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 = 0.01). Prophylactic and symptomatic patients were detethered 1.27 and 1.22 times (p = 0.41). Retethering occurred at 45.9 and 46.9 months (p = 0.49) 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 = 0.026). Prophylactic patients trended towards fewer complications (0.36 vs 0.73, p=0.11). Outcomes were identical in both groups with 91% (p = 0.5) remaining stable or improving at their final follow up.

Conclusions: 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.

Patient Care: By comparing the outcomes of one management strategy versus another using comparable cohorts, we can better assess if one treatment is more efficacious than another. In this fashion, we can better select a treatment that offers the best chance of good outcome while mitigating risk.

Learning Objectives: By the conclusion of the session, participants should be able to 1) identify management strategies for patients presenting with assymptomatic lumbosacral lipomas; 2) recognize the complications associated with prophylactic and detethering after symptomatic worsening; 3) Be able to discuss some of the benefits of prophylactic and surgery after detethering; 4) Identify the long term outcomes associated with a given treatment strategy

References: 1.Kulkarni A V, Pierre-Kahn A, Zerah M: Conservative management of asymptomatic spinal lipomas of the conus. Neurosurgery 54:868–73 2. Pang D, Zovickian J, Oviedo A: Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode, part II: outcome analysis and preoperative profiling. Neurosurgery 66:253–72; discussion 272–3, 2010 3. Sarris CE, Tomei KL, Carmel PW, Gandhi CD: Lipomyelomeningocele: pathology, treatment, and outcomes. Neurosurg Focus 33:E3, 2012 4. Wykes V, Desai D, Thompson DNP: Asymptomatic lumbosacral lipomas--a natural history study. Childs Nerv Syst 28:1731–9, 2012