Idiopathic thoracic spinal epidural lipomatosis causing spinal cord compression

Abstract

A 31-year-old man was admitted to the Emergency Department with complaint of weakness in the lower limbs and a worsening of long-term back pain. The patient had no bowel or bladder problems. On magnetic resonance imaging (MRI), epidural lipomatosis was observed between the T4–T9 levels and was associated with considerable pressure applied to the spinal cord from the posterior aspect (Fig. 1). A multilevel laminectomy and excision of the epidural fatty tissue mass was performed. The patient’s weakness in both legs improved considerably postoperatively. A follow-up MRI obtained 12 months after surgery demonstrated that the cord compression had resolved (Fig. 2). Spinal epidural lipomatosis is an uncommon disease, and its underlying pathologic mechanism is unknown. Magnetic resonance imaging is the diagnostic modality of choice for this disease, and the usual treatment is immediate laminectomy with the removal of epidural fat [1].