Long Term Outcome for Surgical Resection of Pediatric Spinal Lipoma in Kcmh: 20 Years Experience
Keywords:
Spinal lipoma, Tethered cord syndrome, Long tern outcome, Progression-free survival, Cord-sac ratioAbstract
Background: The optimal surgical approach for spinal lipoma remains controversial, particularly in asymptomatic patients. Factors contributing to an increased risk of TCS require further investigation.
Objective: This study aims to analyze the long-term outcomes of patients with spinal lipoma who underwent surgery at King Chulalongkorn Memorial Hospital and identify factors associated with an increased risk of developing TCS.
Methods: A survival analysis was conducted on pediatric patients with spinal lipoma who underwent surgery at King Chulalongkorn Memorial Hospital. Data were retrospectively reviewed for patients who underwent surgery between September 2003 and September 2023 (20 years).
Results: Among 69 patients with a mean follow-up period of 9.6 years, the mean time to progression was 15.7 years, with a progression-free survival (PFS) rate of 84.1% at 19years. The time to retethering ranged from 2 to 17 years after the initial surgery. When analyzing risk factors for TCS, asymptomatic patients had a PFS of 86.7%, while symptomatic patients had a PFS of 79.2%, with no statistically significant difference (p = 0.519). The PFS rates for different spinal lipoma types were as follows: dorsal (50%), transitional (78.6%), chaotic (94.4%), and terminal (89.5%), with no significant difference (p = 0.157). In terms of the extent of resection, patients who underwent complete or near-total resection had a PFS of 94.7%, while those who underwent partial resection had a PFS of 77.3%, with no significant difference (p = 0.071). However, when stratified by cord-sac ratio, PFS rates were 100% for < 0.3, 92.7% for 0.3–0.5, and 50% for > 0.5, demonstrating statistical significance (p = 0.002).
Conclusion: The long-term outcomes of spinal lipoma patients who underwent surgery at King Chulalongkorn Memorial Hospital showed a PFS rate of 84.1%. The cord-sac ratio was the only significant factor associated with an increased risk of developing TCS.
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