Re-untethering surgeries for retethering of spinal lipomas

• Published in: Nervous System in Children Vol. 47; no. 1; pp. 24 - 29
• Main Authors: Yamada, Shuhei, Chiba, Yasuyoshi, Yamada, Junji, Takemoto, Osamu
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Pediatric Neurosurgery 2022
• Subjects: lipomyelomeningocele; re-untethering surgery; retethering; spinal lipoma; surgery-free survival rate
• ISSN: 0387-8023; 2435-824X
• DOI: 10.34544/jspn.47.1_24

Objective: Patients who have undergone prior untethering surgery for spinal lipomas may develop symptomatic retethering as they grow.Methods: We retrospectively studied patients with spinal lipomas who underwent re-untethering surgeries at our institution.Results: The data of one hundred seventy-three patients (76 male and 97 female) were analyzed. The mean age at primary surgery was 2.1 years (median 0.7 years, range 1 day-20.5 years). The mean follow-up period after the primary surgery was 6.1 years (median 4.7 years, range 24 days-16.0 years). Twenty-two patients (12.7%) had undergone re-untethering surgeries. The surgery-free survival rate was 79.4% (95% confidence interval [CI]: 68.3-87.0%) and 63.5% (95% CI: 45.5-76.9%) at 10 and 15 years, respectively. Kaplan-Meier analysis revealed a significant increase in the rate of re-untethering surgeries in patients who were less than a year old at primary surgery (p=0.008), in girls (p=0.02), and patients with lipomyelomeningocele (p=0.04). No postoperative complications were observed in patients who underwent re-untethering surgeries. Furthermore, 80% of patients with worsening symptoms and 100% of patients with worsening MRI findings showed improvement in the preoperative reasons for surgery.Conclusion: There is a significant possibility of retethering, and re-untethering surgeries may need to be performed more aggressively, given their high effectiveness.