Clinical classification and surgical treatment of patients with tethered cord syndrome by conus lipomas

Objective To discuss the clinical classification and surgical treatment for tethered cord syndrome(TCS)ca- sued by conus lipomas.Method A retrospective study was made in which 25 patients with TCS casued by conus lipomas were reviewed,14 male and 11 female patients included,who ranged from 4 months to 48 years in age.All of them were typed by Anti's system and underwent untethering surgery of the spinal cord.Subcutaneous lipomas were resected in the extent ac- cording to the lumbosacral skin condition.The cases were offered 3.2 years of a mean postoperative follow-up period.Result Intraoperative findings were similar to the preoperative MRI manifestations.During the operations,16 patients of dorsal type or caudal type and 2 of combined type lipoma were completely untethered,while 5 patients of combined type and 2 of lipomy- elomeningocele type lipoma were prevented satisfactory surgical removal of the lipoma.Leakage of cerebrospinal fluid was ob- served in 2 cases,and retethered spinal cord in 1 combined type and 1 lipomyelomeningocele patient respectively.6 cases were obviously improved postoperatively,4 in leg paralysis and 2 in aconuresis.However,1 patient with combined type lipo- mas developed neurological deterioration just after surger.Conclusion Proper typing system could contribute to predicting difficulty of untethering operation and prognosis of TCS patients preoperatively.It was useful to avoid leakage of cerebrospinal fluid to prevent complete removal of subcutaneous lipomas.Patients with complicated anatomy of the lesion tended to develop retethering,which could be prevented by enlarge dura sac by high polymer material.Neurological defect could be impreoved postoperatively according to the pathological type.Great progress could be seen in sphincter dysfunction in patients with simple anatomy of the lesion and short period of defect.