Neurosurgical management and pathology of lumbosacral lipomas with tethered cord

Lumbosacral lipomas are the most common form of occult spinal dysraphism. The development of lumbosacral lipomas is from the premature disjunction of the neural tube from the surrounding ectoderm, leaving the neural plate open posteriorly and allowing for the infiltration of mesodermal tissue, including fatty tissue. Since lumbosacral lipomas are a common cause of spinal cord tethering that can lead to progressive neurological deficits, prophylactic neurosurgery for lumbosacral lipomas, including untethering of the spinal cord, is recommended. We briefly review the embryology, classification, clinical presentation, imaging evaluation, surgical indication, neurosurgical management and pathological examination that are involved in recognizing these complicated malformative pathologies.