The lipoma is the most common neoplasm of mesenchymal origin. The majorities of lipomatous lesions are benign and are characterized by slow growth; they are composed of mature adipose tissue organized in lobes, which is, in turn, surrounded by fibrous capsules.
Spinal lipomas are a group of congenital malformations that means they are already present at birth, which is included within the spectrum of hidden spina bifida.
Can Lipomas Cause Back Pain?
There are many types of lipomas depending on the location, they do not produce any symptoms in some patients, but in other cases they do. Spinal lipomas are a type that causes low back pain in young patients and it may appear even when they are at rest or when a physical activity is performed.
There are many types of spinal lipoma. They need to be classified by their location, cervical, thoracic or lumbar, but possibly the most interesting is the lumbosacral lipomas, those that affect the lower region of the spine, the medullary cone. Spinal cord lipomas are by far the most frequent and also those that tend to produce symptoms more frequently.
What Symptoms Do Lipomas Produce?
The symptoms of a spinal lipoma are very variable. They can range from a total absence of symptoms, at least in a specific period of life, to the appearance of more or fewer complex symptoms that can occur at any moment of evolution.
There are patients who present symptoms from birth, including orthopedic deformities or weaknesses in the muscles of the legs. On the other hand, other patients will not have symptoms until very later in the evolution of their lives.
Actually, any symptom that affects the spinal cord and its coverings is possible when we are talking about a lipoma. For instance, an adult or adolescents patients the most common symptom is low back pain. It is a pain with mechanical characteristics and it presents when the patient is sitting or doing any trunk flexion or extension.
When the symptoms appear earlier in the pediatric age they can range from a weakness in the lower limbs, with a more or less marked paresis of the extremities, usually of the feet; orthopedic deformities, that is, deformities in the shape of the feet, which do not cease to be a sample of that muscular weakness that can occur due to the spinal anchorage, or even alterations in the control of the sphincters.
Commonly, the most symptomatic lipomas, that is, caudal or transitional lipomas, can produce weakness in the lower limbs, weakness that is usually progressive, it can produce alterations in the control of the sphincters that is, a neurogenic bladder, the ability to control urine, or may cause alterations in form, for example, of constipation. Finally, when the lipoma has been symptomatic for a long time, it can lead to deformities of the spine, such as scoliosis.
How Are Lipomas Diagnosed?
The diagnosis of lumbar lipoma is usually simple. Lumps are usually observed in the lumbar region, subcutaneous lipomas, deviations of the gluteal fold for instance, and at times cutaneous stigmas in the form of a vascular spot, an angioma, dimple, or areas of hypertrichosis, of increased localized pilosity.
When these lipomas produce symptoms, it is easy to detect a weakness of the lower limbs, an orthopedic alteration or the presence of these cutaneous stigmas, which together will lead doctors to the diagnosis.
The diagnosis is at last by magnetic resonance imaging, an MRI of the lumbosacral region; it will allow diagnosing and defining the type of lipoma and also treatment options.
While it is true that there are lipomas that can persist asymptomatic throughout life, most of them will evolve and give rise to these symptoms, so doctors generally recommend a treatment, which will be preventive or prophylactic in those patients who have no symptoms or have not yet developed them, and who can be effective in controlling some of these symptoms that these patients may have already developed at diagnosis.