Filum Lipoma

Spinal lipoma is one of the congenital abnormalities that affects the spinal cord. The suffix ‘oma’ is used to described a neoplastic event involving in pathophysiology of a lesion. Filum terminale has been termed “The unpaired nerve”, because it is what remains of the spinal cord at the end of the coccyx, was described by Galen. The prevalence of the disease remains unknown. Filum lipoma is a simple close dysraphism without any subcutaneous mass. It occurs because of an abnormality of secondary neurulation. Filum lipoma is benign, overgrowth of fat cells. In normal adults, the incidental fat within filum terminale is about 17%. The most commonly recorded symptoms include pain, sensory disturbance, weakness, and urinary disturbance. The test of choice would of course be magnetic resonance imaging (MRI). It has been suggested that the threshold of diagnosis of thickened filum is 2 mm. The classification of FL is based on whether the conus medullaris is at a normal age-specific position or not in addition to the presence of symptoms (neurological manifestations). Surgical intervention is the choice. Generally, symptomatic patients with low-lying conus medullaris should undergo detethering procedure. This is done by sectioning the thickened filum terminale which interrupts the connection between the conus medullaris and fat-infiltrated and hypertrophied filum. Overall, filar lipoma is considered a benign disease. Its treatment, especially the prophylactic method, carries significantly better prognosis with low complication rate.