Benefits of bariatric surgery on spinal epidural lipomatosis: case report and literature review

Abstract

Spinal epidural lipomatosis is an abnormal accumulation of unencapsulated epidural fat causing compression of the neural elements. It can be divided into idiopathic and secondary. Secondary is often associated with chronic steroid use and endocrinopathies. Idiopathic has been associated with obesity. We report a 48-year-old man with obesity and a history of chronic back pain who developed idiopathic spinal epidural lipomatosis diagnosed by magnetic resonance imaging, which subsequently resolved completely after sleeve gastroplasty over a 6-month follow-up period.

Resolution of idiopathic epidural lipomatosis after bariatric surgery: Case report and literature review

“…As a whole, our case present with the literature [ 28 ] highlights an important role for nonsurgical treatment of SEL and the impact of bariatric surgery on spontaneous resolution of SEL. The aforementioned patient classified as Grade III epidural lipomatosis and has shown that the importance and benefit of the Borré classification for knowing the degree of severity of this lesion.…”

“…[ 5 21 25 26 27 ] There are many cases reported the resolution of SLE on losing weight either by a structured weight loss program and/or by the help of bariatric surgery. [ 23 28 ] The spontaneous accumulation of fat in the epidural space is a dynamic process and sometimes associated with an increase in the peripheral fat mass. [ 28 ] Notwithstanding, the published cases of association between the resolution of symptoms in SEL and weight reduction procedure, the precise mechanisms are not widely understood.…”

“…To date, there are no guidelines for the therapeutic management of SEL. [ 28 ] Further studies of a large population are needed to adequately understand the natural history of this uncommon condition.…”

“…To the best of our knowledge, Valcarenghi et al . [ 28 ] reported the first case of SEL in the literature with complete resolving of symptoms after SG. In this case, we reported the second case report of SEL treated non-surgically with complete clinical and radiological disappearance after SG.…”

Spinal Epidural Lipomatosis: A Comprehensive Review

“…18 More aggressive weight reduction methods, such as bariatric surgery and calorie-restricted diets, have also been noted to provide clinical improvement due to significant loss of epidural fat deposition. 62 Overall, weight reduction may reduce the likelihood of failed management and avoid the need for surgical intervention. 63 For patients on chronic corticosteroids, management is directed at a tapered corticosteroid reduction while ensuring adequate treatment of the underlying condition.…”