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spinal_epidural_lipomatosis

Spinal epidural lipomatosis

Spinal epidural lipomatosis is characterized by abnormal deposition of unencapsulated fat in the epidural space typically in the lumbar region,

The occurrence of this condition as an idiopathic entity is rarely reported.

This condition is usually associated with excess of steroid levels either because of exogenous steroid administration, as in some diseases like systemic lupus erythematosis, or endogenous excess steroid secretion like in Cushing disease or in some other endocrinopathies like hypothyroidism or in morbid obesity 1) 2) 3).


The clinical presentation is progressive spinal cord or nerve root compression.

Radiographic features

Epidural lipomatosis can be visualized with both CT and MRI, although the later is better able to identify impingement upon the cauda equina.

MRI

There is an often generalised excess of fat seen in the extradural space. As a result, the dural sac can appear narrowed or even resemble a “Y” shaped configuration.

Signal characteristics follow fat on all sequences:

T1: high signal

T1 (FS): shows fat suppression

T2: high signal

Treatment

In most instances no specific treatment is required, although review of need for steroid and weight loss are sensible interventions.

The use of epidural steroid injection is controversial. Some authors argue against it, on the grounds of existing compression and implication of steroids in the pathogenesis of epidural lipomatosis 4).

Others report successful pain management 5).

In some patients symptoms are severe and operative decompression is required, and is usually successful 6) 7)

Case reports

2017

A 16-year-old male student, who presented with progressive spastic paraparesis of a one-year duration caused by idiopathic spinal epidural lipomatosis. Magnetic resonance imaging (MRI) study of the thoracic spine revealed marked compression of the spinal cord from a large dorsally located extradural mass extending from the T-4 to T-12 vertebral bodies. The patient underwent posterior thoracic laminoplasty from the T4 to T10 vertebral levels. He experienced gradual neurological, and he was able to walk without assistant by the end of 3-month follow-up period from surgery.

Idiopathic SEL is very rare, since no predisposing factors can be identified, and should be included in the differential diagnosis when patients present with spinal neurological compromise. MRI is the imaging modality of choice, and decompressive laminectomy and debulking of the fatty lesion is the main treatment modality in patients with progressive course of the disease 8).

2016

A 49-year-old man presented with persistent back pain and right hip lump. The lumbar spine X-rays showed scoliosis (Lenke classification 5BN). Lumbar MRI demonstrated circumferential epidural fat deposit from L1 to lower S2 level. There was no obvious etiology of SEL except mild increased body mass index (BMI). The patient was managed with conservative treatment. After 6 months medication (limaprost and ginkgo), his symptoms were relieved 9).


A 46-year-old female with obesity and a history of chronic back pain and radiculopathy who developed idiopathic Spinal epidural lipomatosis diagnosed by magnetic resonance imaging. The purpose of this report is to present a case of spinal epidural lipomatosis presenting with symptomatic cord compression and also remind this rare condition as a the differential diagnosis of epidural lesions in patients with risk factors 10).

1)
Fogel GR, Cunningham PY, Esses SI. Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J. 2005;5:202–11.
2)
Maillot F, Mulleman D, Mammou S, Goupille P, Valat JP. Is epidural lipomatosis associated with abnormality of body fat distribution? A case report. Eur Spine J. 2006;15:105–8.
3)
Beges C, Rousselin B, Chevrot A, Herbold C, Solymosi L, Roosen K. Epidural lipomatosis. Interest of magnetic resonance imaging in a weight-reduction treated case. Spine. 1995;19:251–4.
4)
Rustom DH, Gupta D, Chakrabortty S. Epidural lipomatosis: A dilemma in interventional pain management for the use of epidural Steroids. J Anaesthesiol Clin Pharmacol. 2013;29 (3): 410-1. doi:10.4103/0970-9185.117070
5)
Botwin KP, Sakalkale DP. Epidural steroid injections in the treatment of symptomatic lumbar spinal stenosis associated with epidural lipomatosis. Am J Phys Med Rehabil. 2005;83 (12): 926-30.
6)
Payer M, Van Schaeybroeck P, Reverdin A et-al. Idiopathic symptomatic epidural lipomatosis of the lumbar spine. Acta Neurochir (Wien). 2003;145 (4): 315-20. doi:10.1007/s00701-003-0001-x -
7)
Bodelier AG, Groeneveld W, van der Linden AN et-al. Symptomatic epidural lipomatosis in ectopic Cushing's syndrome. Eur. J. Endocrinol. 2005;151 (6): 765-9.
8)
Al-Yafeai R, Maghrabi Y, Malibary H, Baeesa S. Spinal cord compression secondary to idiopathic thoracic epidural lipomatosis in an adolescent: A case report and review of literature. Int J Surg Case Rep. 2017 Jul 6;37:225-229. doi: 10.1016/j.ijscr.2017.06.041. [Epub ahead of print] PubMed PMID: 28710985.
9)
Han SR. Scoliosis associated with idiopathic lumbosacral epidural lipomatosis. J Spine Surg. 2016 Mar;2(1):72-5. doi: 10.21037/jss.2016.03.03. PubMed PMID: 27683700; PubMed Central PMCID: PMC5039835.
10)
Duran E, Ilik K, Acar T, Yıldız M. Idiopathic Lumbar Epidural Lipomatosis Mimicking Disc Herniation: A Case Report. Acta Med Iran. 2016 May;54(5):337-8. PubMed PMID: 27309484.
spinal_epidural_lipomatosis.txt · Last modified: 2017/07/16 14:59 by administrador