Objective To investigate the relationship between age at surgery, type of pathological anatomy and healing of spinal cord lipoma in children. Methods Retrospective analysis of the clinical data of 211 cases of spinal cord lipoma in children was performed to comprehensively assess the age at surgery, pre- and postoperative rectal bladder function scores and motor function evaluation, intraoperative anatomical staging, and degree of spinal cord relaxation. Results Except for the intramedullary type, there was a significant difference (P < 0.05) between the mean ages of different preoperative bladder and rectal function scores in each pathological anatomical type group. The surgery was able to maintain the original normal function, with an overall improvement rate of 48.3% and an aggravation rate of 0.97% in postoperative rectal bladder function, and an improvement rate of 43.2% and an aggravation rate of 0.96% in locomotion. According to the degree of spinal cord release, 42 cases (100%) of composite type and 13 cases (32.5%) of bulky type were classified as non-dissociable type. Conclusion The children's symptoms worsened with age, which indicates the necessity of early surgery, and surgery has the effect of stabilizing and improving the symptoms, and the non-separable type should not be operated blindly again.