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Spinal Cord Lipoma

Summary

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  • Congenital malformation characterised by abnormal fatty tissue within the spinal cord
  • Often associated with spinal dysraphism and tethered cord syndrome
  • Imaging crucial for diagnosis, with MRI being the modality of choice

Pathophysiology

  • Abnormal embryological development of the neural tube and surrounding mesenchymal tissue
  • Lipomatous tissue infiltrates the spinal cord, causing mass effect and potential neurological deficits
  • Often associated with:
    • Spinal dysraphism
    • Tethered cord syndrome
    • Syringomyelia

Demographics

  • Incidence: 1 in 4,000 live births
  • No significant gender predilection
  • Most commonly diagnosed in infancy or early childhood
  • Can be detected prenatally with advanced imaging techniques

Diagnosis

  • Clinical presentation:
    • Asymptomatic in some cases
    • Cutaneous stigmata (e.g., dimples, hairy patches, subcutaneous masses)
    • Neurological deficits (motor, sensory, or sphincter dysfunction)
    • Back pain
  • Physical examination:
    • Neurological assessment
    • Inspection of the back for cutaneous markers
  • Imaging studies essential for definitive diagnosis

Imaging

  • Magnetic Resonance Imaging (MRI):
    • Gold standard for diagnosis and surgical planning
    • T1-weighted images: Hyperintense signal of fatty tissue
    • T2-weighted images: Variable signal intensity
    • Fat-suppression sequences: Confirm lipomatous nature
  • Computed Tomography (CT):
    • May show low-density fatty tissue
    • Less useful than MRI for soft tissue characterisation
  • Ultrasound:
    • Useful in neonates and infants with open spinal dysraphism
    • Limited utility in older children and adults

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  • A 50-year-old patient presented with a radiculopathy caused by lumbar spondylosis.
  • Incidentally, the distal cord was expanded by a fat-containing lesion and was associated with a dilated central canal.

Treatment

  • Conservative management:
    • For asymptomatic patients or those with minimal symptoms
    • Regular clinical and radiological follow-up
  • Surgical intervention:
    • Primary goal: Untether the spinal cord and decompress neural elements
    • Debulking or resection of lipoma to avoid neurological injury
  • Long-term follow-up essential due to risk of re-tethering and progressive neurological deficits

Differential diagnosis

Differential Diagnosis Differentiating Feature
Spinal cord tumour Lipomas show fat signal on MRI, while other tumours typically do not
Tethered cord syndrome Lipomas may cause tethering, but not all tethered cords have lipomas
Myelomeningocele Lipomas are intradural, while myelomeningoceles are open neural tube defects
Dermoid cyst Dermoids have heterogeneous signal on MRI, lipomas are homogeneous
Epidermoid cyst Epidermoids restrict on diffusion-weighted imaging, lipomas do not
Arachnoid cyst Arachnoid cysts follow CSF signal on all sequences, lipomas follow fat signal
Syringomyelia Syrinx contains fluid, lipomas contain fat on imaging
Neurofibroma Neurofibromas enhance with contrast, lipomas typically do not
Arteriovenous malformation AVMs show flow voids on MRI, lipomas do not