Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 Oct 2:26:33.
doi: 10.1186/s12998-018-0203-1. eCollection 2018.

Spinal epidural lipomatosis presenting to a U.S. Veterans Affairs pain and rehabilitation department: a report of two cases

Keith M Silcox  1 , Clinton J Daniels  2   3 , Glenn A Bub  3   4 , Pamela J Wakefield  3   4 , James D Toombs  4   5
Affiliations
Case Reports

Spinal epidural lipomatosis presenting to a U.S. Veterans Affairs pain and rehabilitation department: a report of two cases

Keith M Silcox et al. Chiropr Man Therap. .

Abstract

Background: Spinal epidural lipomatosis is an uncommon source of neurogenic claudication. We present two cases of spinal epidural lipomatosis as it relates to diagnosis, management, and a possible association with common medical intervention.

Case presentation: Case 1: 63-year old male patient presented with neurogenic claudication symptoms, but without evidence of bony central canal stenosis on lumbar computed tomography. He entered a trial of spinal manipulation with transient beneficial gains after seven appointments, but no durable change in neurogenic claudication. An MRI was recommended at this point which revealed grade III spinal epidural lipomatosis at the L5/S1 level.Case 2: 51-year old male patient presented to a pain management physician with radicular symptoms for a series of lumbar epidural steroid injections. He completed a series of three lumbar epidural steroid injections with only short-term benefit. A repeat MRI demonstrated the presence of grade I (borderline grade II) spinal epidural lipomatosis.

Conclusions: The first case illustrates a limitation of ruling out central canal stenosis with computed tomography for patients unable to undergo an MRI. The second case demonstrates a possible association between steroid injections and spinal epidural lipomatosis. An association of this kind has not been established; further research is needed to determine the significance.

Keywords: Case series; Chiropractic; Epidural fat; Epidural steroid injection; Lipomatosis; Spinal stenosis.

PubMed Disclaimer

Conflict of interest statement

KMS performed literature review and prepared the manuscript. CJD provided patient care and assisted in preparation of the manuscript. GAB and PJW provided supervision and editorial review. JDT provided patient care and editorial review. All authors’ read and approved the final manuscript.The Saint Louis Veterans Health Affairs privacy officer and Research Development Committee provided approval for publication of this report and associated images.Written informed consent was obtained from the patients for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
CT bone window image of L4–5 which does not clearly demonstrate evidence of spinal epidural lipomatosis
Fig. 2
Fig. 2
case 1, visualization of the “Y” sign indicating grade III compression
Fig. 3
Fig. 3
case 1, measurement of the “Y” sign using the modified method. “A” demonstrates the dural sac as measured with the modified method, “B” demonstrates the spinal canal, and EF is the difference between these measurements
Fig. 4
Fig. 4
case 2, epidural fat measurement pre LESI, demonstrating a grade 0, or normal finding. “A” demonstrates the spinal canal, “B” demonstrates the dural sac, and EF is the difference between these measurements. The L4–5 disc herniation is not visualized on this image
Fig. 5
Fig. 5
case 2, pre LESI imagine without measurements. The L4–5 disc herniation is not visualized on this image
Fig. 6
Fig. 6
case 2, post LESI imagine without measurements
Fig. 7
Fig. 7
case 2, epidural fat measurement post LESI, demonstrating a grade I (borderline grade II) SEL. “A” demonstrates the spinal canal, “C” and “D” demonstrates the EF on either side of the dural sac, and the dural sac is the difference between A and C + D
See this image and copyright information in PMC

References

    1. Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update) Spine J. 2013;13(7):734–743. doi: 10.1016/j.spinee.2012.11.059. - DOI - PubMed
    1. Borre DG, Borre GE, Aude F, Palmieri GN. Lumbosacral epidural lipomatosis: MRI grading. Eur Radiol. 2003;13:1709–1721. doi: 10.1007/s00330-002-1716-4. - DOI - PubMed
    1. Sugaya H, Tanaka T, Ogawa T, Mishima H. Spinal epidural lipomatosis in lumbar magnetic resonance imaging scans. Orthopedics. 2014;37(4):e362–e366. doi: 10.3928/01477447-20140401-57. - DOI - PubMed
    1. Fogel GR, Cunningham PY, Esses SI. Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J. 2005;5(2):202–211. doi: 10.1016/j.spinee.2004.05.252. - DOI - PubMed
    1. Koch CA, Doppman JL, Patronas NJ, Nieman LK, Chrousis GP. Do glucocorticoids cause spinal epidural lipomatosis? When endocrinology and spinal surgery meet. TEM. 2000;11(3):86–90. - PubMed

Publication types