Symptomatic Spinal Epidural Lipomatosis Research Articles

Percutaneous full-endoscopic uniportal decompression for the treatment of symptomatic idiopathic lumbar spinal epidural lipomatosis: Technical note.

BackgroundLumbar spinal epidural lipomatosis (SEL) is a rare condition characterized by an excessive accumulation of adipose tissue within the spinal canal, compressing the dura sac and/or nerve roots. When conservative treatments fail and clinical symptoms progress quickly and seriously, surgical decompression should be considered. With the rapid development of endoscopic armamentaria and techniques, the pathological scope that can be treated by percutaneous endoscopic spine surgery is ever expanding.ObjectiveIn this paper, the authors describe a patient with lumbar spinal epidural lipomatosis who was treated with a percutaneous full-endoscopic uniportal decompression surgery successfully. This article aims to validate the feasibility of percutaneous full-endoscopic uniportal decompression for the treatment of symptomatic idiopathic spinal epidural lipomatosis via interlaminar approach.MethodsWe describe a case of a 69-year-old man with a 10-year history of low back pain, intermittent claudication, and bilateral leg neuropathic pain. He was diagnosed with lumbar epidural lipomatosis, which did not respond to conservative therapy. After a comprehensive evaluation, he underwent percutaneous endoscopic spine surgery to remove hyperplastic adipose tissue and decompress nerve roots and dura sac.ResultsThe patient was treated with a percutaneous full-endoscopic uniportal decompression surgery successfully. After the procedure, his leg pain decreased and his walking capacity improved. There were no surgery-related complications, such as cerebrospinal fluid leakage, incision infection, etc.ConclusionsThe case with SEL was successfully treated with a percutaneous full-endoscopic uniportal surgery, which has the advantages of excellent presentation of anatomical structures, expanded field of vision, less surgical-related trauma, and bleeding. The key point of the procedure is to release and cut off the bands which divide the epidural space into small rooms filled with excess adipose tissue.

Spinal Epidural Lipomatosis Causing Lumbar Canal Stenosis: A Pictorial Essay on Radiological Grading and the Role of Bariatric Surgery Versus Laminectomy

Spinal epidural lipomatosis (SEL) is a rare condition characterized by an excessive accumulation of adipose tissue in the spinal canal that can have a compressive effect on intraspinal neuroanatomical structures, leading to clinical symptoms. Several different conservative and surgical treatment strategies have been proposed but the treatment and outcomes remain controversial. There is a lack of severity-based evidence documenting the success of decompressive laminectomy in SEL and there are only anecdotal reports of clinico-radiological success with weight loss from bariatric surgery. This article demonstrates the resolution of SEL in two patients with bariatric surgery with the help of pre and postoperative MR imaging. The authors also highlight the classic “types” of spinal epidural lipomatosis with a surgically relevant grading system and elucidate the existence of concurrent extraspinal lipomatosis (i.e. mediastinal and intra-abdominal lipomatosis), drawing parallels with the natural history of SEL. The controversial question remains whether a symptomatic SEL patient needs a multilevel laminectomy for spinal decompression or bariatric surgery that can indirectly help the spinal condition. We propose that bariatric intervention could be better frontline management in patients with multifocal/multisystem lipomatosis (i.e., combined spinal and extraspinal) and spinal decompression would be ideal for those SEL patients with coexisting bony and/or ligamentous spinal canal or foraminal stenosis. This manuscript serves as a comprehensive and contemporary update on the radiological profile and two plausible treatment paths and will look toward further verification by a randomized clinical trial.

Lumbar Epidural Lipomatosis is Increased in Patients With Morbid Obesity and Subsequently Decreases After Bariatric Surgery

Spinal epidural lipomatosis (SEL) is characterized by symptomatic neurogenic compression from adipose tissue in the spinal canal. The question arises whether patients with morbid obesity have higher volumes of epidural adipose tissue (EAT) in their lumbar spinal canal compared with patients with a normal weight, and to what extent this decreases after bariatric surgery. In this explorative study the lumbar EAT volume was assessed in 25 patients with morbid obesity (body mass index [BMI] >40) using available lumbar magnetic resonance imaging (MRI) prior to their bariatric surgery. An age- and sex-matched control group (n= 25) of patients with a normal weight (BMI 20-25) was used for comparison. Participants from the obesity group underwent a postoperative control MRI. The mean volume of EAT per MRI slice of the group of patients with obesity was significantly higher than for the group of patients with normal weight (mean: 83.3 ± 30.7 mm3 vs. mean 56.5 ± 25 mm3; P < 0.001). Fifteen participants with obesity (15 of 25) agreed to undergo a follow-up MRI. There was a significant decrease in EAT volume per MRI slice for these 15 participants (mean 82 ± 25.5 mm3 vs. 46 ± 20.0 mm3; P < 0.001) over time up to 3.6 (range: 1.2-6.0) years after bariatric surgery. Patients with obesity have significantly larger volumes of EAT in comparison with patients with normal weight. After bariatric surgery, a significant weight loss coincided with a significant volumetric reduction of this adipose tissue in the spinal canal. Future prospective studies in patients with symptomatic SEL may elucidate whether decreases in EAT volume influence concurrent neurogenic claudication symptoms.

Spinal epidural lipomatosis: a rare association of Cushing's disease.

SummaryExcess cortisol is associated with hypertrophy and redistribution of adipose tissue leading to central obesity which is classically seen in Cushing’s syndrome. Abnormal accumulation of fatty tissue in the spinal canal is most commonly associated with chronic steroid therapy and rarely reported with endogenous Cushing’s syndrome. Herein, we describe a case of spinal epidural lipomatosis (SEL) associated with Cushing’s disease. A 17-year-old man was referred with lower limb weakness, weight gain, multiple stretch marks, back pain and loss of height. He had clinical and biochemical features of Cushing’s syndrome. MRI and Inferior Petrosal Sinus Sampling (IPSS) confirmed a pituitary adenoma as the source. On day 1 post trans-sphenoidal adenectomy he developed spastic paraparesis with a sensory deficit to the level of T5. MRI spine showed increased fat deposition in the spinal canal from T2 to T9 consistent with a diagnosis of SEL. He was managed conservatively and made a good recovery following restoration of eucortisolism and a period of rehabilitation. Learning points:SEL is a serious complication of glucocorticoid excess and should be considered in any patient presenting with new lower limb neurological symptoms associated with hypercortisolism.It is important to distinguish symptomatic SEL from cortisol-induced proximal myopathy by good history and clinical examination.MRI of the spine is the gold standard investigation for making a diagnosis of SEL.Restoration of eucortisolism can lead to resolution of fat accumulation and good neurological outcome.

Lumbar cystic epidural lipomatosis with mass effect. Report of an unusual case

We present a rare case of symptomatic cystic lumbar spinal epidural lipomatosis that required surgical treatment via a minimally invasive tubular laminectomy. To our knowledge this is the first pathology confirmed report of compressive cystic lumbar spinal epidural lipomatosis available in literature.

A Novel Free Radical Pathway for the Formation of Unprecedented Nitrogen-centered Chiral DNA Adducts by the Classic Chemical Hydroxamic Acid Carcinogen in Vitro and in Vivo

We present a rare case of symptomatic cystic lumbar spinal epidural lipomatosis that required surgical treatment via a minimally invasive tubular laminectomy. To our knowledge this is the first pathology confirmed report of compressive cystic lumbar spinal epidural lipomatosis available in literature.

A Novel Percutaneous Biportal Endoscopic Technique for Symptomatic Spinal Epidural Lipomatosis: Technical Note and Case Presentations

To describe a minimally invasive decompression technique for symptomatic spinal epidural lipomatosis using percutaneous biportal endoscopic surgery. In this report, we describe the indirect decompressive effect that was gained by partial laminotomy and ligamentum flavectomy under biportal endoscopic view. Direct neural decompression was then performed by removal of proliferated fat. We described the technical process and compared pre- and postoperative radiating leg pain, life quality, and a radiologic grading system of neural compression. This technique was performed successfully in 3 patients with idiopathic spinal epidural lipomatosis. Radiating pain was reduced, and functional disability and radiologic compression were improved. Postoperative instability and surgical complications related to the procedure were not observed. Percutaneous spinal endoscopy is a minimally invasive muscle-preserving technique for spinal lipomatosis that achieves neural decompression directly by lipoma removal and indirectly by partial bone and ligament removal.

Symptomatic Idiopathic Spinal Epidural Lipomatosis in 9 Patients: Clinical, Radiologic, and Pathogenetic Features

Symptomatic spinal epidural lipomatosis (SSEL) is characterized by hypertrophy of adipose tissue within the spinal canal and consequent neural compromise. The exact pathogenesis remains enigmatic. The authors describe a retrospective case series, define the full clinical spectrum, and discuss possible pathogenetic mechanisms. The medical notes and imaging of 9 patients with SSEL undergoing surgery from 2008-2018 were analyzed. Seven patients presented secondary to lumbosacral spinal epidural lipomatosis (SEL); 3 patients with chronic incomplete cauda equina syndrome (CES), 3 patients with acute CES (including a 25-week gravid patient and a 40-year-old patient with intravenous leiomyomatosis, both of whom had mild SEL) and 1 patient with chronic lumbar radiculopathy. In addition, 2 patients presented with progressive myelopathy secondary to thoracic SEL. Patients presenting with acute CES had a mean age of 37 years (range 23-49 years) and mean extradural fat (EF)-to-spinal canal (SC) ratio of 47% (range 41%-58%), in comparison with patients with chronic CES; mean age 61 years (range 58-65 years) and EF:SC ratio 72% (range 65%-80%). Patients underwent laminectomy and resection of EF at compressive levels. All patients with CES experienced complete resolution of symptoms at follow-up (range 1-48 months). The clinician should be astute to the radiologic features of SEL, particularly in patients presenting with CES in the absence of acute disk herniation. The outcome of patients with CES and SEL after surgery is excellent regardless of symptom duration. Venous impedance related to increased body mass index and EF deposition may play the predominant role in addition to mechanical compression in the pathogenesis of SSEL.

Spinal Epidural lipomatosis due to adrenal cortisol secreting adenoma in a 14 year old girl - a case report

Background: Spinal epidural lipomatosis (SEL) is an excessive fat deposition within the epidural space of spinal canal leading to compression of nervous structures and neurological manifestations. Exogenous glucocorticoid administration is the major cause of symptomatic SEL. The reported patient had SEL related to endogenous Cushing syndrome which is among few reported cases in the literature. Case presentation: A 14 year girl with features of Cushing syndrome had severe back pain and magnetic resonance imaging of spine showed SEL. Subsequently, computed tomography of abdomen showed right adrenal adenoma.The patient underwent adrenalectomy which improved her signs of hypercortisolism and SEL. Conclusion: In view of severe neurological deficits and therapeutic consequences, SEL should be considered in all patients with Cushing syndrome who present with symptoms of spinal cord compression. Correction of underlying endocrinopathy is imperative in management of SEL.

The Clinical Characteristics of Spinal Epidural Lipomatosis in the Lumbar Spine.

BackgroundSpinal epidural lipomatosis (SEL) is a rare disease, defined as diffuse hypertrophy of unencapsulated adipose tissue causing spinal canal compression and progressive neurologic deficits. However, there are few studies on SEL in Korea.ObjectivesThe purpose of this study was to describe the prevalence and clinical characteristics of SEL in Korea.MethodsOf the 3702 symptomatic patients (1575 males and 2127 females) who underwent lumbar spine magnetic resonance imaging (MRI) at the age of 20 years or older from January 2014 to December 2016, 42 patients (27 males and 15 females) diagnosed with SEL were selected. Medical records and telephone counseling were used to document sex, age, height, weight, clinical symptoms, coexistent spinal disease, accompanying diseases, and alcoholism and smoking status. One radiologist classified the severity of epidural lipomatosis into three grades from I to III according to Borre et al. We obtained four linear measurements at the axial plane parallel based in the narrowest on MRI image.ResultsThe incidence of SEL in the lumbar spine was 1.1%, which was 1.71% in men and 0.7% in women. The mean age was 69.4 ± 10.9 years and the mean body mass index (BMI) was 26.4 ± 3.5 kg/m2. The most common clinical symptoms were lower back pain and radiating leg pain (26 patients, 61.9%). The level of affected SEL was found to be most prevalent at L5 - S1 (21 patients, 50%). Concomitant diseases were hypertension (26 patients, 61.9%) and diabetes (12 patients, 28.5%). The most common SEL grade was type III (21 patients, 50%), followed by types II (17 patients, 40.4%) and I (4 patients, 9.5%).ConclusionsLumbar spine MRI at one hospital showed that the incidence of symptomatic SEL was 1.1%; SEL is common at the L5-S1 level and in male patients, and severity grade is often severe.

Symptomatic spinal epidural lipomatosis after combined hormonal and steroidal palliative therapy of prostate cancer.

Spinal epidural lipomatosis (SLE) is an abnormal accumulation of unencapsulated fat. The association of chronic steroid therapy is described as well as obesity and Cushing's syndrome. SLE has a range of neurological presentations such as back pain, myelopathy, and cauda equina syndrome. Surgical decompression is known to improve symptomatic cases and prevent further deterioration. An elderly male patient with background history of high-risk metastatic prostate cancer and long-term treatment with steroids and hormonal therapy presented with acute on chronic back pain and neurological symptoms. Spinal cord compression was excluded on the subsequent MRI. However, a spinal epidural lipomatosis causing significant central canal stenosis and compression of the cauda equine was revealed. With the increasing role of MRI in assessing back pain, asymptomatic spinal epidural lipomatosis has been frequently noticed. However, symptomatic presentation after long term combined treatment of steroids and hormonal therapy has not been reported in the literature.

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.

Symptomatic Spinal Epidural Lipomatosis with Severe Obesity at a Young Age

Symptomatic spinal epidural lipomatosis is a rare disorder characterized by overgrowth of fat in the extradural space. Most patients have an underlying endocrine disorder, such as Cushing's syndrome, or have taken exogenous steroids chronically. Although less common, obesity alone is thought to be a cause of spinal epidural lipomatosis, representing <25% of reported cases. Patients rarely become symptomatic before middle age without chronic exogenous steroid use. The usual clinical manifestations are similar to degenerative lumbar stenosis with neurogenic claudication, resulting in decreased walking and standing endurance with variable neurological deficits.This article describes 2 unique cases of spinal epidural lipomatosis, both in young patients with underlying morbid obesity who presented with acute progressive leg weakness and urinary retention. The patients had no underlying endocrinopathy, nor any history of exogenous steroid use. They underwent emergency laminectomy and removal of epidural fat, and histopathological examination confirmed the diagnosis of epidural lipomatosis. Postoperatively, the patients demonstrated significant improvement.We conducted a review of the available English literature and compared the age distribution in each group. Based on our review, our 2 patients are considerably younger than those in past reports, especially in the patient group to which the steroid was not administered. In addition, few cases exist of spinal epidural lipomatosis with acute sphincter dysfunction and paraparesis. Our cases suggest that morbid obesity can lead to juvenile spinal epidural lipomatosis with acute neurological changes.

Spinale epidurale Lipomatose: be- oder verkannt?

Summary Spinal epidural lipomatosis: a known or unknown quantity? Symptomatic spinal epidural lipomatosis (SEL) of the thoracic or lumbar spine is a rare disease. With a pathomechanism that is poorly understood, it is most commonly observed in patients with long-term exogenous steroid therapy, endogenous steroid overproduction or obesity; idiopathic SEL is even less common. The signs and symptoms of SEL depend on the level and degree of spinal cord and/or nerve root compression and are identical with those fro m degenerative bony or ligamentous stenosis or disc herniation, i.e. myelopathy, radiculopathy or neurogenic claudication. The best diagnostic tool is MRI, where a focal increase in epidural fat is seen as hyperintensity on T 1 - and T 2 -weighted sequences. Recognition of SEL is important, since effective thera- peutic options exist such as weight and/or steroid reduction. Should conserva- tive treatment fail, or in severe cases, surgical decompression is a possibility which offers good results.

Epidural Lipomatosis

Object Idiopathic symptomatic spinal epidural lipomatosis (SEL) is a rare condition, and few reports have discussed diagnostic imaging criteria. To evaluate factors relating to its clinical symptoms, correlations between clinical features and the presence of spinal epidural fat were investigated, and the literature concerning idiopathic SEL was reviewed. Methods Morphological gradings of epidural fat were evaluated in seven patients with idiopathic SEL by using magnetic resonance (MR) imaging. In addition, body mass index (BMI), the number of involved vertebral levels, grade, and preoperative Japanese Orthopaedic Association (JOA) score were analyzed. Surgery resulted in symptomatic relief, with a mean JOA score recovery rate of 67.4%. Grading of epidural fat tended to display a slight negative correlation with preoperative JOA score, whereas a strong significant positive correlation was found between the number of involved vertebral levels and BMI. Conclusions The number of involved vertebral levels and obesity are strongly correlated, whereas severity of dural compression is not always significantly associated with neurological complications. These results indicate that epidural fat of the lumbar spine contributes to neurological deficits. In addition, weight-reduction therapy appears to decrease the number of vertebral levels involved. Magnetic resonance imaging–based grading is helpful for the diagnosis and evaluation of idiopathic lumbar SEL. Moreover, symptoms and neurological findings are important for determining the surgical approach.

Epidural Lipomatosis

Object Idiopathic symptomatic spinal epidural lipomatosis (SEL) is a rare condition, and few reports have discussed diagnostic imaging criteria. To evaluate factors relating to its clinical symptoms, correlations between clinical features and the presence of spinal epidural fat were investigated, and the literature concerning idiopathic SEL was reviewed. Methods Morphological gradings of epidural fat were evaluated in seven patients with idiopathic SEL by using magnetic resonance (MR) imaging. In addition, body mass index (BMI), the number of involved vertebral levels, grade, and preoperative Japanese Orthopaedic Association (JOA) score were analyzed. Surgery resulted in symptomatic relief, with a mean JOA score recovery rate of 67.4%. Grading of epidural fat tended to display a slight negative correlation with preoperative JOA score, whereas a strong significant positive correlation was found between the number of involved vertebral levels and BMI. Conclusions The number of involved vertebral levels and obesity are strongly correlated, whereas severity of dural compression is not always significantly associated with neurological complications. These results indicate that epidural fat of the lumbar spine contributes to neurological deficits. In addition, weight-reduction therapy appears to decrease the number of vertebral levels involved. Magnetic resonance imaging–based grading is helpful for the diagnosis and evaluation of idiopathic lumbar SEL. Moreover, symptoms and neurological findings are important for determining the surgical approach.

Idiopathic spinal epidural lipomatosis: urgent decompression in an atypical case

Symptomatic spinal epidural lipomatosis (SEL) is very rare and frequently associated to chronic exogenous steroid use, obesity and Cushing syndrome. The idiopathic cases where no identifiable association with SEL are found constitute only 17% of all cases. The usual clinical manifestations of this entity consist of dorsal or lumbar pain with paresthesias and weakness in lower limbs, but acute symptoms of myelopathy are exceptional. We report a case of acute paraparesis and urinary retention caused by thoracic SEL in a 55-year-old male who did not have any recognized predisposing factor for this condition. Urgent surgical decompression was performed in order to relieve the symptoms. Slow but progressive improvement was assessed after surgery. We consider this case to be exceptional due to the needing to perform an urgent decompressive laminectomy to treat a rapidly progressive myelopathy caused by idiopathic SEL.

Acute spinal cord compression

Case of the monthAcute spinal cord compressionD Butteriss and V JayakrishnanD ButterissDepartment of Neuroradiology, Regional Neurosciences Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UKSearch for more papers by this author and V JayakrishnanDepartment of Neuroradiology, Regional Neurosciences Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UKSearch for more papers by this authorPublished Online:5 Mar 2014https://doi.org/10.1259/bjr/53147199SectionsPDF/EPUBFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail About References 1 Lee M, Lekias J, Gubbay SS, Hurst PE. Spinal cord compression by extradural fat after renal transplantation. Med J Aust 1975;1:201–3. Crossref Medline ISI, Google Scholar2 Robertson SC, Traynelis VC, Follett KA, Menezes AH. Idiopathic spinal epidural lipomatosis. Neurosurgery 1997;41:68–75. Crossref Medline ISI, Google Scholar3 Geers C, Lecouvet FE, Behets C, Malghem J, Cosnard G, Lengele BG. Polygonal deformation of the dural sac in lumbar epidural lipomatosis: an anatomic explanation by the presence of meningovertebral ligaments. AJNR Am J Neuroradiol 2003;24:1276–82. Medline ISI, Google Scholar4 Borre DG, Borre GE, Aude F, Palmieri GN. Lumbosacral epidural lipomatosis: MRI grading. Eur Radiol 2003;13:1709–21. Crossref Medline ISI, Google Scholar5 Deogaonkar M, Goel A, Tingare K, Dahiwadkar H, Nagpal H. Extradural lipomatosis presenting with paraplegia. J Postgrad Med 1995;41:85–6. Medline, Google Scholar6 Fassett DR, Schmidt MH. Spinal epidural lipomatosis: a review of its causes and recommendations for treatment. Neurosurg Focus 2004;16:1–3. Medline, Google Scholar Previous article Next article FiguresReferencesRelatedDetailsCited byLumbar Epidural Lipomatosis is Increased in Patients With Morbid Obesity and Subsequently Decreases After Bariatric SurgeryWorld Neurosurgery, Vol. 158Lumbar spinal epidural lipomatosis: A case report and review of the literatureInternational Journal of Surgery Case Reports, Vol. 78Benefits of bariatric surgery on spinal epidural lipomatosis: case report and literature review24 April 2018 | European Journal of Orthopaedic Surgery & Traumatology, Vol. 28, No. 7Considering Symptomatic Spinal Epidural Lipomatosis in the Differential Diagnosis10 August 2012 | American Journal of Hospice and Palliative Medicine®, Vol. 30, No. 6 Volume 80, Issue 956August 2007Pages: 591-e192 © The British Institute of Radiology History ReceivedSeptember 01,2005RevisedFebruary 13,2006AcceptedFebruary 20,2006Published onlineMarch 05,2014 Metrics Download PDF

Decompression of idiopathic symptomatic epidural lipomatosis of the lumbar spine

Epidural lipomatosis has been implicated as a cause or contributor of symptomatic lumbar spinal stenosis. Symptomatic spinal epidural lipomatosis (SEL) of the lumbar spine is a rare disease, often associated with steroid overload. Idiopathic lipomatosis is even much less frequent. Signs and symptoms depend upon the level and degree of nerve root compression. Diagnosis is best based on MRI. Weight reduction can be curative, however, after failure of medical treatment or in severe cases surgical decompression should be performed. A 70-year-old man with both lower limb severe paresthesia and radicular symptoms unrelieved with conservative treatments such as medications and physical therapy was treated by surgical decompression. Obesity, endocrinopathic disease, and chronic steroid therapy were excluded. Interlaminar fenestration, lateral recess decompression and fat debulking were applied at all levels through the L2–S1. After surgery there was a gradual improvement in symptoms. We report a rare case of idiopathic SEL which has shown entire evolvement of lumbar spine with specific increase of radiological and clinical severity from L2–3 to L5–S1 in a non-obese patient.

Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature

Idiopathic symptomatic spinal epidural lipomatosis (SEL) is a rare condition, and few reports have discussed diagnostic imaging criteria. To evaluate factors relating to its clinical symptoms, correlations between clinical features and the presence of spinal epidural fat were investigated, and the literature concerning idiopathic SEL was reviewed. Morphological gradings of epidural fat were evaluated in seven patients with idiopathic SEL by using magnetic resonance (MR) imaging. In addition, body mass index (BMI), the number of involved vertebral levels, grade, and preoperative Japanese Orthopaedic Association (JOA) score were analyzed. Surgery resulted in symptomatic relief, with a mean JOA score recovery rate of 67.4%. Grading of epidural fat tended to display a slight negative correlation with preoperative JOA score, whereas a strong significant positive correlation was found between the number of involved vertebral levels and BMI. The number of involved vertebral levels and obesity are strongly correlated, whereas severity of dural compression is not always significantly associated with neurological complications. These results indicate that epidural fat of the lumbar spine contributes to neurological deficits. In addition, weight-reduction therapy appears to decrease the number of vertebral levels involved. Magnetic resonance imaging-based grading is helpful for the diagnosis and evaluation of idiopathic lumbar SEL. Moreover, symptoms and neurological findings are important for determining the surgical approach.