Comparison of Outcomes of Early and Late Surgical Interventions in Lipomeningomyelocele (LMMC) and Lipomeningocele (LMC)

Abstract

Objectives:  The study compared the signs and symptoms of post-operative complications in early vs. late intervention lipomeningomyelocele (LMMC) and lipomeningocele (LMC). Materials and Methods:  We compared the clinical and surgical data between two groups i.e., lipomeningomyelocele (n = 189) and lipomeningocele (n = 64), and their early vs. late surgical interventions for 3 years from January 2018 to July 2021. We included patients of both genders (n = 253) with lipomeningomyelocele or lipomeningocele aged up to 7 years. A detailed neurological exam i.e., sensory, motor, and cerebellar signs was performed to evaluate the patients. Results:  The presentation of LMMC (74.7%) was very high compared to LMC (25.3%). 74.7% underwent detethering of the spinal cord, as they had cord tissue coming out of the defect. 25.2% had only meninges coming out of the bony deficiency and performed dural repairs. 47 patients had incontinence which was improved postoperatively. Sixty-nine patients had hydrocephalus which was treated with VP shunt or ETV. 23 patients had diastematomyelia which is a bony spur duly repaired intra-operatively. 50 presented with paraplegia and 19 cases with club feet. The majority of patients in both groups, reported for Power would fall between 3/5-4/5. For patients who underwent late intervention, 7 presented with post-operative incontinence, 12 with hydrocephalus, 12 with CSF leakage, and 13 with paraplegia. Conclusion:  If performed on time, surgical intervention in lipomeningocele and lipomeningomyelocele yields good results. Early intervention is substantially better for managing post-op CSF leakage and incontinence than late intervention.