Lumbar spinal epidural lipomatosis: A case report and review of the literature

Abstract

Introduction: Lumbar spinal epidural lipomatosis (SEL) is a rare condition defined by an excessive deposition of adipose tissue in the lumbar spinal canal. The objective of this case report is to document a clinical case of SEL presenting within a multidisciplinary spine clinic and to compare our clinical findings and management with the available literature.

Case presentation: A 51-year-old female presented at a spine clinic with low back pain, bilateral leg pain and difficulty walking. Magnetic resonance imaging of the lumbar spine showed evidence of severe central canal stenosis due to extensive epidural lipomatosis. She was initially advised to lose weight and undergo a 3-month course of physiotherapy. However, because of lack of improvement, she was scheduled for and underwent L4-S1 posterior spinal decompression and L4-L5 posterior spinal instrumented fusion. At 12-month follow-up, the patient reported no pain and retained the ability to walk regular distances without experiencing discomfort.

Discussion: This case report describes the conservative and surgical management of a case of lumbar spinal stenosis due to SEL. The therapeutic approach of patients with this condition is not standardized. As such, a discussion of the literature with respect to the diagnosis, clinical presentation, epidemiology, imaging appearance, risk factors, etiology, and management of SEL is also presented.

Keywords: Case report; Conservative care; Low back pain; Posterior spinal decompression; Posterior spinal instrumented fusion; Spinal epidural lipomatosis.

Fig. 1

A,B: Sagittal T1-weighted MR images. A. Normal patient image for comparison; B. Patient image. The image of our patient (B) reveals a thick layer of abundant subcutaneous fat (*) and a thick proliferation of epidural fat (arrows) compressing and displacing the dural sac toward the anterior. Observe on the normal image (A) that both subcutaneous fat and epidural fat are less abundant and cause no compression or displacement of the dural sac. C,D: Axial T1-weighted MR images. C. Normal patient image for comparison; D. Patient image. Image C of a normal patient shows a very thin rim of epidural fat surrounding the circular shaped dural sac with no evidence of compression. The axial image of our patient (B) shows dramatic proliferation of epidural fat (arrows) compressing the dural sac into a trefoil shape to approximately 25% of its normal size. Note also the abundance of subcutatneous fat (*) in our patient compared to the normal patient.

Fig. 2

Postoperative frontal (A) and lateral (B) lumbosacral radiographs reveal absence of spinous processes and laminae at L4 and L5 representing evidence of laminectomy. Bilateral pedicle screw and rod instrumentation has resulted in L4-5 arthrodesis (fusion) and small surgical clips are present within the L4-5 disc space related to discectomy at this level.