To explore the clinical effect and significance of preventive surgery for asymptomatic spinal lipomas in children. We retrospectively analysed the clinical data of 168 patients with asymptomatic spinal lipoma from April 2001 to June 2019, Shanghai Department of Neurosurgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine. The patients were aged from 1.5 months to 15 years (the average age was 7 months), and there were no neurological symptoms, such as pain, incontinence, and/or bilateral lower limb dysfunction, before surgery. The surgical procedure included completely removing the lipomas in subcutaneous and extramedullary tissues of the spinal cord, subtotal resection of intraspinal fat, and separating the spinal cord, including the medullary conus from the dura sac, to release the tethered cord. For the 168 children with spinal lipomas included in the study, complete resection was undertaken for the dorsal spinal lipomas, and subtotal resection was performed for the transitional lipomas. Subcutaneous effusion caused by cerebrospinal fluid leakage occurred in 5 cases after surgery and was cured after multiple punctures and aspiration. Six patients developed mild incontinence immediately after the operation, 5 of whom completely returned to normal within 1 month, and 1 had no relief of symptoms. A total of 159 of the 168 patients were followed up for 3 to 19 years (the median follow-up time was 76 months). Longterm postoperative symptoms were observed in 13 patients (7.7%), including 12 cases of spinal cord retethering and 1 case of lipoma enlargement. Preventive surgery can reduce the future incidence of neurological dysfunction in children with asymptomatic spinal lipomas.