Spinal Epidural Lipomatosis Research Articles

Unusual Spinal Epidural Lipomatosis and Lumbosacral Instability.

Introduction. Epidural lipomatosis is most frequently observed in patients on chronic steroid treatment. Only a few idiopathic epidural lipomatosis cases have been described. Material and Methods. 64-year-old male patient presented with low back pain and left leg pain. Later, the patient experienced neurogenic claudication and radicular pain in the left leg without urinary dysfunction. Plain radiography and magnetic resonance imaging demonstrated an abnormal fat tissue overgrowth in the epidural space with compression of the dural sac, degenerative disc disease at L4-L5 level, and instability at L5-S1. Endocrinopathic diseases and chronic steroid therapy were excluded. If conservative treatment failed, surgical treatment can be indicated. Results. After surgery, there was a gradual improvement in symptoms and signs, and six months later the patient returned to daily activities and was neurologically normal. Conclusion. In the absence of common causes of neurogenic claudication, epidural lipomatosis should be considered. The standard test for the diagnosis of epidural lipomatosis is magnetic resonance (MR). At first, conservative treatment must be considered; weight loss and the suspension of prior corticosteroid therapy are indicated. In the presence of neurological impairment, the operative treatment of wide surgical decompression must be performed soon after diagnosis.

Poster 66 Spinal Epidural Lipomatosis in the Setting of Chronic Steroid Use: A Case Report

Poster 66 Spinal Epidural Lipomatosis in the Setting of Chronic Steroid Use: A Case Report

Spinal Epidural Lipoma

Spinal epidural true lipoma is exceedingly rare. It can mimic the symptoms of disk herniation and sometimes is difficult to distinguish it from spinal epidural lipomatosis or angiolipoma. We report a case of a 43-year-old male patient presenting with low back pain and neurological deficits of right lower extremity, who was diagnosed and surgically treated. A search using Medline database is conducted and 6 other patients in the literature are found. Common symptoms included sciatica, motor weakness, and sensation loss. Most cases involved the lumbar region. Only 1 case was in the cervical cord (C5-C6). Conservative treatments failed in all cases. All cases performed mass extirpation through laminectomy or laminae fenestration. Prognoses were good in general. Spinal epidural lipoma is rare but should not be neglected. It can worsen the situation when accompanied with trauma. We suggest that surgeries should be carried out in symptomatic patients. More research attention should be paid in the etiology and histology of this disease in the future.

Back Pain in HIV-Infected Patients May Be Due to Spinal Epidural Lipomatosis

Spinal epidural lipomatosis (SEL) is an abnormal accumulation of normal adipose tissue in the extradural space within the spinal canal that can lead to notable spinal cord compression. It is most commonly reported in patients receiving chronic glucocor¬ticoids. Other causes can include obesity and hypercortisolism. Unusually, SEL may occur in human immunodeficiency virus (HIV)-infected patients, and has been attributed to the lipodystrophy and altered fat metabolism associated with antiretrovirals. We describe a 56-year-old, HIV-infected, non-obese woman with satisfactory immunovirological indices on combined antiretroviral therapy who developed debilitating back pain initially attributed to osteoarthritis. A thorough neurological work-up with magnetic resonance imaging (MRI) led to the diagnosis of rapidly progressive SEL that was not associated with any of its common etiologies.

Spinal epidural lipomatosis: presentation of two idiopathic cases and review of the literature

Spinal epidural lipomatosis (SEL) is a rare cause of low back pain and radiculopathy and is usually associated with exogenous steroid therapy and endocrinopathy. The idiopathic form is even more rare and presented mainly in obese patients. SEL appears in the lumbar and thoracic spine and has never been reported in the cervical spine. The deposition of adipose tissue in the spinal canal produces slowly progressing symptoms (low back pain and intermittent claudication) due to compression of the spinal cord and roots. Surgical therapy provides immediate relief, but has a reported mortality rate of over 20%, due to the co-morbidity of these patients. We present two cases of lumbar radiculopathy due to idiopathic spinal epidural lipomatosis. One patient was treated surgically (removal of excessive epidural adipose tissue combined with decompressive laminectomy and foraminotomy), while the other was placed under a low-calorie diet and both improved neurologically.

Cauda Equina Syndrome Caused by Idiopathic Epidural Lipomatosis.

Spinal epidural lipomatosis (SEL) is a rare condition that presents as a back pain with progressive neurologic symptoms. Most affected patients are obese and receiving steroid therapy, or have an endocrinopathies. We report a rare case of cauda equina syndrome caused by SEL in a non-obese healthy young man without any evident traumatic episode. A healthy 19-year-old man, who had experienced lower back pain for two months, visited our emergency room because of the sudden development of motor weakness and voiding difficulty. Lumbar magnetic resonance image revealed extradural fat compressing the cauda equina. Urgent decompression via posterior laminectomy and excision of excess epidural fat resulted in an immediate symptom improvement.

Unusual presentation of spinal lipomatosis

Spinal epidural lipomatosis (SEL) is a rare condition characterized by overgrowth of normal adipose tissue in the extradural space within the spinal canal that can lead to significant spinal cord compression. It is most commonly reported in patients receiving chronic glucocorticoid therapy. Other causes can include obesity and hypercortisolism. Occasionally, idiopathic SEL will occur in patients with no known risk factors, but cases are more generally reported in obesity and males. We present the case of a 35 year-old non-obese woman found to have rapidly progressive SEL that was not associated with any of the common causes of the disorder.

Transforaminal epidural steroid injection in the treatment of lumbosacral radicular pain caused by epidural lipomatosis: A case series and review

Spinal epidural lipomatosis (SEL) can cause radicular pain due to spinal nerve root impingement. While SEL decompression surgery can provide symptom relief, these patients are often poor surgical candidates due to elevated BMI or immunosuppression. Transforaminal epidural steroid injection (TFESI) has been attempted as an alternative treatment for patients with SEL who are unable to tolerate conservative medical treatment. To date, only two such cases have been reported in the literature. We report three additional cases of radicular pain associated with SEL, review the current literature on this condition, and describe the risks and benefits of using TFESI to treat radicular pain due to SEL. We measured changes on the pain visual analogue scale (VAS) and pain disability index (PDI) from presentation to 1-5 weeks after treatment with sequential TFESIs. Pain VAS scores improved by 50-75% and PDI scores improved 13-44 points. This case series suggests that TFESI can provide modest short-term symptom relief of lumbosacral radicular pain and improvement in disability caused by SEL. Further study of non-operative management of SEL is warranted, given the high risk associated with surgery in this population.

(130) Lumbar epidural lipomatosis causing symptomatic central canal stenosis: a case report

Spinal epidural lipomatosis is a rare accumulation of adipose in the epidural space which has been linked to corticosteroid use or Cushing’s disease which can progress clinically from mild stenosis to cord compression. We present a 54 year old male with past medical history of asthma, on daily inhaled corticosteroids, who presented with progressively worsening low back pain, bilateral radicular leg pain and claudication. Initial lumbar spine MRI showed disc bulge with mild narrowing of left L5-S1 neural foramen, L5-S1 facet hypertrophy, and minimal fat accumulation consistent with early signs of epidural lipomatosis.

Idiopathic Lumbar Epidural Lipomatosis

We present two cases of idiopathic spinal epidural lipomatosis. Case 1: A 77-year-old man experienced tightness in bilateral lower extremities and neurogenic claudication for 1 year. He was overweight with a body mass index of 30.8 kg/m2. Magnetic resonance imaging revealed extensive epidural lipomatosis of lumobsacral spine with significant constrictive compression of the thecal sac. Case 2: A 78-year-old man presented with low back pain along with progressive pain and numbness in the left lower extremity and neurogenic claudication for 6 months. He was diabetic with body mass index of 25.6 kg/m2. Magnetic resonance imaging demonstrated circumferential compression of the thecal sac due to increased epidural fat tissue at the L4 level. We suggest that spinal epidural lipomatosis should be considered in the differential diagnoses when patients with neurological symptoms have conditions relating to hyperinsulinism such as obesity and exogenous steroid administration

Lumbosacral epidural lipomatosis causing rapid onset cauda equina syndrome

Spinal epidural lipomatosis (SEL) is a rare cause of cauda equina syndrome (CES), which must be diagnosed with MRI in conjunction with a high level of clinical suspicion. Most reported cases are associated with obesity, steroid use or are secondary to endocrinopathies, frequently present subacutely or chronically, and have been managed with both surgical decompression and non-operative measures. We describe an obese 55-year-old man with rapid onset CES secondary to idiopathic lumbosacral SEL which was managed successfully with surgical decompression. Although often thought to be a trivial radiological finding, it is important not to be dismissive of patients presenting with compressive neuropathy and MRI evidence of space-occupying SEL.

Myelopathy in patients under chronic steroid therapy: remember spinal epidural lipomatosis

Fig. 1. Sagittal magnetic resonance imaging of the thoracic spine (Top Left: T1; and Top Right: T2) demonstrating an epidural mass with signal characteristics compatible with fat (white arrows) (hyperintense in T1 and less hyperintense in T2 than the cerebrospinal fluid). (Bottom) Axial T2 cut at the level of T5–T6 level, as shown in the green line of sagittal section. Fig. 2. Intraoperative picture after T3–T11 laminoplasty. Note the thick and hard layers of abnormal epidural fat over the posterior epidural space.

Spontaneous resolution of spinal epidural lipomatosis

Spinal epidural lipomatosis (SEL) is an abnormal accumulation of unencapsulated, epidural fat. SEL can be divided into idiopathic and secondary. Secondary SEL is often associated with chronic steroid use and endocrinopathies. Idiopathic SEL has been associated with obesity. SEL has been implicated in a variety of neurologic impairments and surgical decompression has been shown to prevent further worsening or result in improvement. We report a 53-year-old man with obesity and a history of chronic back pain who developed idiopathic SEL diagnosed by MRI, which subsequently resolved completely over an 8month follow-up period. To our knowledge, this is the first reported case of complete radiographic resolution of SEL without any treatment.

Epidural Lipomatosis as a Cause for High Impedance Values During a Spinal Cord Stimulator Trial

A spinal cord stimulator (SCS) trial often involves the percutaneous placement of trial leads in the epidural space and has been used to treat a variety of chronic pain conditions, including complex regional pain syndrome I and II, failed back surgery syndrome, radi culopathy, postherpetic neuralgia, ischemic chest and limb pain, spinal cord injury, and phantom limb pain [1,2]. Spinal epidural lipomatosis (SEL) is seldom considered a contraindication for an SCS trial. In this Clinical Pearl, we present the case of a patient who did not respond to a percutaneous SCS trial and who had abnormally high impedance levels at a spinal level that directly correlated with the presence of a large area of thoracic SEL, which was discovered on subsequent thoracic magnetic resonance imaging (MRI).

Steroid-induced Spinal Epidural Lipomatosis after Suprasella Tumor Resection.

Spinal epidural lipomatosis (SEL) is an abnormal localized accumulation of fat tissues in the epidural space. It is strongly related with steroid administration. The symptoms of SEL are various and range from back pain to paraplegia. In severe cases, decompressive laminectomy is the choice of treatment. A 32-year-old woman who had been under long-term steroid administration after suprasellar tumor resection was admitted for both leg radiating pain and weakness. She was diagnosed with SEL and had a decompressive laminectomy. During the operation, we found the nerve roots were compressed by epidural fat tissues and engorged vessels. After the operation, her radiating pain was relieved and motor weakness was improved.

Steroid-induced Paraparesis: Spinal Epidural Lipomatosis Complicated by a Wedge Deformity of the Middle Thoracic Vertebrae

Steroid therapy is commonly prescribed, although a variety of complications have been reported. Among such complications, spinal epidural lipomatosis is rare and difficult to diagnose before paraparesis occurs. The purpose of this report is to present a rare but catastrophic complication of steroid therapy. A 64-year-old woman undergoing long-term steroid therapy suffered from an osteoporotic vertebral compression fracture and was unable to walk due to paraparesis. Magnetic resonance imaging (MRI) demonstrated a D7 compression fracture and stored epidural adipose tissue between D5 and D8. After surgery, the patient was able to walk with double canes. This case indicates that long-term steroid use has the potential to induce paraparesis.

Y-sign and other diagnostic findings in idiopathic spinal epidural lipomatosis

Y-sign and other diagnostic findings in idiopathic spinal epidural lipomatosis

Spinal Epidural Lipomatosis

Retrospective study. To find out if spinal epidural lipomatosis (SEL) occurs more commonly among patients with Scheuermann disease than in the general population. On the basis of our own radiologic and operative observation, SEL seems to occur frequently in patients with Scheuermann disease. Magnetic resonance imaging of 87 individuals (72% male, average age 19±6 y) from 2 centers (29 consecutive patients with Scheuermann disease and 58 controls) were retrospectively evaluated by 2 neuroradiologists. Spinal epidural fat (EF) at seventh thoracic vertebra (EF7), maximum EF (EFmax), dural sac diameter at T7 and at the level of maximum EF (DS7 and DSmax) were measured. EF ratios at T7 (EFR7) and at maximum EF (EFRmax) were calculated as EF/DS. Body mass index (BMI) for study population and kyphosis severity for the patients were recorded. Mann-Whitney, Spearman correlation, and χ tests were performed dependent on the variable in question. EF7, DS7, EFmax, EFR7, and EFRmax was significantly higher among patients with Scheuermann disease (EFmax 5.7±2.4 mm) than among controls (EFmax 3.8±1.1 mm), P<0.001. Twelve patients with Scheuermann disease (41%) fulfilled our proposed criteria for the diagnosis of SEL (EFmax>6 mm+EFRmax>0.51) compared with 2 (3%) among controls (P<0.001). Patients with Scheuermann disease exhibited higher BMI than controls (24.9±5 kg/m vs. 22.9±4 kg/m, P=0.138). Logistic regression showed that the occurrence of SEL among patients with Scheuermann disease was independent of BMI (P=0.880). The degree of kyphosis in patients with Scheuermann's disease (62±20°) was correlated to the amount of the EF. As SEL occurs more frequently among patients with Scheuermann disease, spine magnetic resonance imaging should be routinely performed to screen each of these patients to avoid impending neurological injury during surgery, especially in those exhibiting SEL.

Epidural lipomatosis causing new debilitating back pain in a patient with human immunodeficiency virus on highly active antiretroviral therapy

Spinal epidural lipomatosis is a rare condition of adipose tissue hypertrophy in the epidural space. Through nerve root and spinal canal compression, it may lead to both sensory and motor compromise. Chronic steroid use, obesity and other metabolic derangements are known causes of spinal epidural lipomatosis. Recently, several cases have been attributed to antiretrovirals taken to treat human immunodeficiency virus, given their side effects of lipodystrophy and altered fat metabolism. We report a patient on highly active antiretroviral therapy (HAART) who developed debilitating back, hip and thigh pain during the third trimester of pregnancy that prevented ambulation. Epidural lipomatosis was diagnosed by magnetic resonance imaging. Given her evolving symptoms, neuraxial anesthesia was considered to be contraindicated. We present her management and labor course.

Considering Symptomatic Spinal Epidural Lipomatosis in the Differential Diagnosis

Spinal epidural lipomatosis (SEL) is the abnormal accumulation of normal fat within the spinal canal. It is more frequent in those patients receiving chronic glucocorticoid therapy or in cases of endogenous hypercortisolism states. We report a case of SEL in a patient with metastatic prostate cancer with history of steroid treatment as part of his chemotherapy regimen, presenting with clinical manifestations of partial cord compression. Magnetic resonance imaging images of the lumbar spine revealed the presence of epidural tumor suspicious for metastatic disease. Operative findings were consistent with epidural lipomatosis. Spinal epidural lipomatosis is a rare condition that needs to be included in the differential diagnosis of patients with risk factors, presenting with symptomatic cord compression.