A retrospective analysis of spinal teratomas and spinal lipomas: overlaps and differences in presentation, surgical treatments, and outcomes.

Background: Spinal teratomas and lipomas, both adult and pediatric cases, are rare diseases with many similarities, but have yet to be systematically compared.

Purpose: To systematically compare spinal teratomas and lipomas to optimize management.

Study Design: Retrospective.

Patient Sample: Symptomatic spinal teratoma and lipoma patients surgically treated at our center.

Outcome Measures: Anatomical distribution, clinical manifestations, resection status, and outcomes.

Methods: Spinal teratoma and lipoma patients with complete data treated during 2008 to 2023 in our center were enrolled. Electrophysiological monitoring was routinely performed after 2012. Patient characteristics, anatomical distribution, clinical manifestations, surgical resection, and outcomes were analyzed.

Results: We enrolled 86 teratoma patients (71 adults) and 51 lipoma patients (39 adults). Most tumors were lumbosacral lesions; cervical/thoracic involvement was more common with lipomas. Pain, the most frequent manifestation, was more common in teratomas. Gross total resection (GTR) was achieved in 51.1% and 49% of teratomas and lipomas, respectively. Electrophysiological monitoring increased the GTR rate from 38.8% to 48.6%. Age independently predicted (OR: 1.040, 95% CI: 1.008-1.078) GTR/near-total resection (NTR). Symptom relief occurred in 81.4% teratoma patients and 64.7% lipoma patients. Recurrence/symptomatic progression occurred in 19 teratomas and 7 lipomas after a median of 95 and 115 months, respectively. Adult lipoma patients without spinal dysraphism had lower recurrence rates. GTR (HR: 0.172, 95% CI: 0.02557-0.7028) and lesion length (HR: 1.351, 95% CI: 1.138-1.607) independently predicted recurrence/progression.

Conclusions: GTR should be pursued for adult/pediatric spinal teratomas and pediatric spinal lipomas. For adult spinal lipoma patients without dysraphism, conservative surgery could be considered.