External validation of a new classification of spinal lipomas based on embryonic stage

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OBJECTIVE

Contention exists regarding appropriate classification and management of spinal lipomas (SLs). Given the heterogeneity of SLs, omissions and overlap between surgically incomparable groups exist in conventional classification systems. The new classification of spinal lipoma (NCSL) recently proposed by Morota et al. delineates morphology by embryological pathogenesis and the resultant operative difficulty. Here, the authors aimed to validate the NCSL by applying it to patients who had been operated on at their institution.

METHODS

All children who had undergone resection for SL between 2014 and 2018 were included in this analysis. MRI studies were independently reviewed and classified by three adjudicators. Baseline characteristics, inter-adjudicator agreement, coexisting anomalies and/or malformations, and postoperative outcomes and complications were analyzed.

RESULTS

Thirty-six patients underwent surgical untethering for SL: NCSL type 1 in 5 patients (14%), type 2 in 14 patients (39%), type 3 in 4 patients (11%), and type 4 in 13 patients (36%). All classification was agreed on first assignment by the adjudicators. Radical or near-radical resection, which was attempted in all patients, was always possible in those with type 1 and 4 SL, but never in those with type 2 and 3 SL. Neurological stabilization and/or improvement were observed in all patients at the last follow-up.

CONCLUSIONS

The NCSL was found to be a logical and reproducible system to apply in this SL population. All cases were successfully classified with a high degree of inter-assessor agreement. Widespread establishment of a commonly adopted and clinically useful classification system will enable clinicians to improve patient selection as well as discussion with patient representatives during the decision-making process.

ABBREVIATIONS IOM = intraoperative neurophysiological monitoring; NCSL = new classification of spinal lipoma; NEM = Necker-Enfants Malades; SL = spinal lipoma; VACTERL = vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal anomalies, and limb abnormalities.
Article Information

Contributor Notes

Correspondence Pasquale Gallo: Royal Hospital for Sick Children, Edinburgh, United Kingdom. pasqualegallo@nhs.net.INCLUDE WHEN CITING Published online January 24, 2020; DOI: 10.3171/2019.11.PEDS19575.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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