Neurosurgery Spine Fellow Tulane-Ochsner Metairie, LA, US
Introduction: Spinal lipomas are rare tumors compromising only 1% of intradural lesions, with the majority related to failure of disjunction and presenting in childhood with abnormalities of the distal cord or filum terminale. We present a case of an adult non-dysraphic cervical intradural lipoma presenting with cervical myelopathy and systematically review the literature to evaluate previously published reports to guide surgical management.
Methods: A systematic review of the literature was performed to identify studies containing individual cases or series of intradural spinal lipomas from 1/1/2000-present excluding thoraco-lumbar cases and associations with spinal dysraphism. Outcomes of interest included the decision for surgical intervention including fusion, extent of resection, recurrence, and neurologic recovery after intervention.
Results: 51 studies were collected, 45 were excluded based on the above criteria, totaling 7 patients including our case. The average age of presentation was 30.3 years, the most common presentation was cervical myelopathy: difficulty walking, clumsiness, hand numbness and paresthesia. Our patient presented with progressive cervical myelopathy and an intradural extramedullary lipoma from C2-7 with severe cord compression and 3/5 strength on exam. 1 patient was observed, 6 underwent surgical intervention which included posterior cervical laminectomy (6 cases), fusion (2 cases), and laminoplasty (1 case). All of the surgeries achieved subtotal resection. Reported follow up averaged 2.4 years with 4 patients improving neurologically, 1 with significant recurrence and neurologic decline and 1 without symptomatic change.
Conclusion : Progressive cervical myelopathy from intradural cervical lipoma not associated with congenital anomaly or spinal dysraphism is an exceedingly rare condition. Posterior cervical fusion (C2-T2) with laminectomy (C2-7) and subtotal intradural resection achieved favorable neurologic outcome in our case. We describe this rarely encountered neurosurgical intradural tumor including presentation, associated conditions, management, and outcome, and illustrate our case with analysis of reported results in the literature.