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Thread: New to Forum - Spinal Lipoma T12-L1

  1. #1

    Question New to Forum - Spinal Lipoma T12-L1

    I am new to the forum and feel stupid posting this here but I am at a loss for help. I know my issues are nothing compared to many of you, that is why I feel stupid but I too know there is much knowledge on this forum and I am asking you to share yours.
    I have a problem with a lipoma in which I am seeking advice. I have had low back pain for about 10yrs. Recently 8/06, the pain started in my right groin and radiated down anterior right thigh. The pain began then bilaterally and in buttocks/hips and with vaginal pressure and rectal pressure. I had an MRI which stated - Impression: 1. "Fatty Mass located at the right lateral aspect of the conus that slightly displaced to conus to the left and distorts portions of the cauda equina. The signal intensity of the lesion suggests that is is composed mainly of fat, however, there is some heterogeneity of the lesion without appreciable enhancement. The mass measures 1.2x0.7x3.1 cm - ap, transverse and craniocaudal dimensions. Diagnostic considerations would include a dermoid or a lipoma. An epidermoid would be considered less likely. 2. Lumbar discogenic disease, predominantly confined to the L4-L5 and L5-S1 levels. There is mild central canal stenosis and bilateral foraminal stenosis at these levels." My neurologist had me complete a myelogram which stated - Impression: 1. " Mild lower spondylosis including mild central canal stenosis at L4-L5 secondary to mild disc bulging and ligamentum flavum thickening. 2. Mild disc bulging without central canal stenosis at L5-S1. 3. Mild compromise of the transversing left S1 nerve rot within the lateral recess at L5-S1 secondary to hypertrophic facet osteophyte and a mild asymmetric disc bulge. 4. Lipoma of the conus medullaris displacing the conus slightly to the left without causing central stenosis or cord compression, Lipoma is at T12-L1 along the right aspect of the conus medullaris. Lipoma measures 0.8 cm transverse by 3.2 cm craniocaudal by 1.0 cm AP, it extends caudally along the proximal most aspect of the right cauda equina." I went back to the Neurologist that stated "the risk of surgery is not worth the reward - possibly causing paralysis. My neurologist also stated "this is a congenital anamoly and it probably won't cause anymore problems". I also sent my myelogram to a Dr. Jallo in Baltimore, MD and he stated, " I do believe the lipoma on the right maybe tethered. You may need surgical intervention to untether the lipoma but the timing is not clear." Well needless to say I have alot of unanswered questions.

    My symptoms vary every day - right inguinal pain, rectal pressure, bialteral thigh pain - sometimes radiates to right foot, buttock pain, vaginal pressure, low back pain - it is different every single day - some days worse than others. The inguinal pain is like a burning. I have had constipation all my life (not hard stool just hard to get out - atonic colon? with pain at times) stress incontinence for about a year (like with coughing and as of lately with sex) but I have had 3 children and contributed the incontinence to that and could possibly be. I think the incotinenece is getting worse because I dribble alot now. I am to see a urologist on the 27th. My legs feel so VERY heavy, like I am dragging cement blocks around. I am 5 foot 4 and weigh 135 lbs so I am not over weight. I believe the cord does tether due to alot of my symptoms but I don't know for sure. My body at times feels worn out like I can't stand very long - I need to lay down. I only take Atacand for HTN and levoxyl due to thyroidectomy. Due to my profession I am on my feet alot and of course the longer the duration of standing the worse it hurts at the end of the day.

    Thank you in advance for any insight you can give to me. Also, if any one knows a professional in Kansas City area that could help me ie: NeuroSurgeon I would be so thankful. I do not care for the Dr. I have at this time.

    Teresa

  2. #2
    I can't help but I think somebody will come along that can. Just want to wish you luck.

  3. #3
    Quote Originally Posted by teresa-gail
    I am new to the forum and feel stupid posting this here but I am at a loss for help. I know my issues are nothing compared to many of you, that is why I feel stupid but I too know there is much knowledge on this forum and I am asking you to share yours.
    I have a problem with a lipoma in which I am seeking advice. I have had low back pain for about 10yrs. Recently 8/06, the pain started in my right groin and radiated down anterior right thigh. The pain began then bilaterally and in buttocks/hips and with vaginal pressure and rectal pressure. I had an MRI which stated - Impression: 1. "Fatty Mass located at the right lateral aspect of the conus that slightly displaced to conus to the left and distorts portions of the cauda equina. The signal intensity of the lesion suggests that is is composed mainly of fat, however, there is some heterogeneity of the lesion without appreciable enhancement. The mass measures 1.2x0.7x3.1 cm - ap, transverse and craniocaudal dimensions. Diagnostic considerations would include a dermoid or a lipoma. An epidermoid would be considered less likely. 2. Lumbar discogenic disease, predominantly confined to the L4-L5 and L5-S1 levels. There is mild central canal stenosis and bilateral foraminal stenosis at these levels." My neurologist had me complete a myelogram which stated - Impression: 1. " Mild lower spondylosis including mild central canal stenosis at L4-L5 secondary to mild disc bulging and ligamentum flavum thickening. 2. Mild disc bulging without central canal stenosis at L5-S1. 3. Mild compromise of the transversing left S1 nerve rot within the lateral recess at L5-S1 secondary to hypertrophic facet osteophyte and a mild asymmetric disc bulge. 4. Lipoma of the conus medullaris displacing the conus slightly to the left without causing central stenosis or cord compression, Lipoma is at T12-L1 along the right aspect of the conus medullaris. Lipoma measures 0.8 cm transverse by 3.2 cm craniocaudal by 1.0 cm AP, it extends caudally along the proximal most aspect of the right cauda equina." I went back to the Neurologist that stated "the risk of surgery is not worth the reward - possibly causing paralysis. My neurologist also stated "this is a congenital anamoly and it probably won't cause anymore problems". I also sent my myelogram to a Dr. Jallo in Baltimore, MD and he stated, " I do believe the lipoma on the right maybe tethered. You may need surgical intervention to untether the lipoma but the timing is not clear." Well needless to say I have alot of unanswered questions.

    My symptoms vary every day - right inguinal pain, rectal pressure, bialteral thigh pain - sometimes radiates to right foot, buttock pain, vaginal pressure, low back pain - it is different every single day - some days worse than others. The inguinal pain is like a burning. I have had constipation all my life (not hard stool just hard to get out - atonic colon? with pain at times) stress incontinence for about a year (like with coughing and as of lately with sex) but I have had 3 children and contributed the incontinence to that and could possibly be. I think the incotinenece is getting worse because I dribble alot now. I am to see a urologist on the 27th. My legs feel so VERY heavy, like I am dragging cement blocks around. I am 5 foot 4 and weigh 135 lbs so I am not over weight. I believe the cord does tether due to alot of my symptoms but I don't know for sure. My body at times feels worn out like I can't stand very long - I need to lay down. I only take Atacand for HTN and levoxyl due to thyroidectomy. Due to my profession I am on my feet alot and of course the longer the duration of standing the worse it hurts at the end of the day.

    Thank you in advance for any insight you can give to me. Also, if any one knows a professional in Kansas City area that could help me ie: NeuroSurgeon I would be so thankful. I do not care for the Dr. I have at this time.

    Teresa
    Teresa,

    Based on your description, you have new pain and a lipoma that is situated exactly in the location to explain the pain. The neurosurgeons are probably correct in surmising that you have had this lipoma for a long time but I am persuaded by both the distribution and history of your pain that it results from the lipoma. Lipomas do grow with age. It is reasonably large (0.8 x 3.2 x 1.0 cm for your spinal canal) and is pressing on a crucial part of your spinal cord. You are showing symptoms of bladder compromise.

    In my opinion, it should be removed. Lipomas tend to form a plane with the spinal cord and it should not be so dangerous to remove it. An experienced surgeon should be able to remove it without posing much risk to your spinal cord. You will, however, need to find an experienced neurosurgeon. Are you in Kansas City MO? If so, I know a spinal neurosurgeon there. His name is Barry Festoff (BW Festoff, Neurobiology Research Laboratory (151), VA Medical Center, 4801 Linwood Blvd, Kansas City, MO 64128, USA) and he may be either able to see you or refer you to somebody that he knows.

    I just looked on internet for spinal neurosurgeons and found two at Midwest Neurosurgery Associates. Although I don't know either personally, they appear to be very experienced spinal surgeons. Dr. Kaufman graduated from Case Western and has been practicing for 42 years (Source). Dr. Chilton graduated from the University of Rochester and has been practicing for 26 years.

    Andrew B Kaufman MD
    Midwest Neurosurgery Associates
    6420 Prospect, T411
    Kansas City Missouri 64132
    Neurosurgeon
    Tel: 816.363.2500

    Jonathan D Chilton MD
    Midwest Neurosurgery Associates
    6420 Prospect
    Kansas City MO 61432
    Neurosurgeon
    Tel: 816-363-2500

    I found 6 spinal neurosurgeons in Kansas City, Kansas but don't know any of them personally.

    Wise.

  4. #4
    Thank you for responding. I have made an appt. with Dr. Chilton and I am in the process of making one with a Dr. Paul Arnold who is an associate of Dr. Festoff. I appreciate your guidance Dr. Young. That is the info. I have been needing. I am not excited to have surgery but my gut instinct tells me that there is comprimise on the cord and I am slowing feeling the effects. A part of me says do nothing and let it go but I have also read that if damage has or was to happen there is little chance of regaining what I have lost. Once again, thank you and I will keep you posted.

    Sincerely,
    Teresa

  5. #5
    Thanks Betheny for words of encouragement. I am orignally from Oklahoma so its nice to hear from another Okie! Okie's are always good, down to earth people.

    Teresa

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