Epidural lipomatosis: case report and literature review

Hierholzer, J.; Benndorf, Goetz; Lehmann, T; Schneider, Gerd‐Helge; Podrabský, P; Sander, B.; Sörensen, R.; Siekmann, Ralf; Stoltenburg, G.; Felix, R

doi:10.1007/bf00596585

Cited by 41 publications

(16 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The extreme compression of the thecal sac leads to neurologic dysfunction that may be insidious or precipitous, intermittent or continuous, including low back pain [3,4,6,7,8,9,12,24,26], radicular pain [7,24,26,27], neurogenic claudication [3,6,20,28,29], and, in some cases, cauda equina syndrome [20,30,31,32]. Hence, this MRI grade III may be considered as severe (symptomatic) LEL.…”

Section: Grade IIImentioning

confidence: 98%

“…Third, this axial plane is a sensitive level for the detection of increased amounts of fat since LEL, in its more common type, always involves the L5-S1 level, ascending in some severe cases up to the L2-L3 level. The "segmentary" type of LEL only confined to L3 or L4 without caudal extension is extremely infrequent [12,13].…”

Section: Linear Measurements and Indexesmentioning

confidence: 99%

See 1 more Smart Citation

Lumbosacral epidural lipomatosis: MRI grading

Borré¹,

Borré²,

Aude³

et al. 2002

Eur Radiol

122

148

View full text Add to dashboard Cite

Lumbosacral epidural lipomatosis (LEL) is characterized by excessive deposition of epidural fat (EF). The purpose of our retrospective study was to quantify normal and pathologic amounts of EF in order to develop a reproducible MRI grading of LEL. In this study of 2528 patients (1095 men and 1433 women; age range 18-84 years, mean age 47.3 years) we performed a retrospective analysis of MRI exams. We obtained four linear measurements at the axial plane parallel and tangent to the superior end plate of S1 vertebral body: antero-posterior diameter of dural sac (A-Pd DuS), A-Pd of EF, located ventrally and dorsally to the DuS, and A-Pd of the spinal canal (Spi C). We calculated (a) DuS/EF index and (b) EF/Spi C index. We developed the following MRI grading of LEL: normal, grade 0: DuS/EF index >or=1.5, EF/Spi C index or=75% (severe EF overgrowth). The MRI exams were evaluated independently by three readers. Intra- and interobserver reliabilities were obtained by calculating Kappa statistics. The MRI grading showed the following distribution: grade 0, 2003 patients (79.2%); LEL grade I, 308 patients (12.2%); LEL grade II, 165 patients (6.5%); and LEL grade III, 52 patients (2.1%). The kappa coefficients for intra- and interobserver agreement in a four-grade classification system were substantial to excellent: intraobserver, kappa range 0.79 [95% confidence interval (CI), 0.65-0.93] to 0.82 (95% CI, 0.70-0.95); interobserver, kappa range 0.76 (95% CI, 0.62-0.91) to 0.85 (95% CI, 0.73-0.97). In LEL grade I, there were no symptomatic cases due to fat hypertrophy. LEL grade II was symptomatic in only 24 cases (14.5%). In LEL grade III, all cases were symptomatic. A subgroup of 22 patients (42.3%) showed other substantial spinal pathologies (e.g., disk herniation). By means of simple reproducible measurements and indexes MRI grading enables a distinction between mild, moderate, and severe EF hypertrophy. Kappa statistics indicate that LEL can be reliably classified into a four-grade system by experienced observers.

show abstract

Section: Grade IIImentioning

confidence: 98%

Section: Linear Measurements and Indexesmentioning

confidence: 99%

Lumbosacral epidural lipomatosis: MRI grading

Borré¹,

Borré²,

Aude³

et al. 2002

Eur Radiol

122

148

View full text Add to dashboard Cite

show abstract

“…There was no significant difference in the cumulative dosage of prednisone per kilogram between patients with SSEL and patients without SSEL in our study. Meanwhile in only 8 of 56 patients (14.3%), with the exception of our 5 patients, [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25] has the cumulative dosage of prednisone per kilogram been described (250, 293, 328, 347, 409, 418, 780, 1,480 mg/ kg, respectively). In 9 of 13 patients (69.2%), including our patients, SSEL occurred within a prednisone dosage of about 400 mg/kg.…”

Section: Discussionmentioning

confidence: 87%

“…Of 41 SSEL patients with known weight and height, 31 (75.6%) were obese [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25]. Furthermore, there were some reports [26] that pa- Osteoporosis tients with severe obesity and without glucocorticoids had idiopathic SEL, and that treatment including a weight reduction program in obese patients improved the SEL [27].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, to our previous three cases at Dokkyo University School of Medicine Hospital [7] we have added two more new children with SSEL in this study. Hierholzer et al [8] described 33 patients with SSEL in a literature review in 1996. We have identified another 29 patients, including 3 French and 2 Japanese reports [1,4,5,6,7,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25], and we therefore review a total of 62 patients, including 12 children.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Spinal epidural lipomatosis in children with renal diseases receiving steroid therapy

et al. 2004

View full text Add to dashboard Cite

Spinal epidural lipomatosis (SEL) in patients on steroid therapy may be explained by two hypotheses: (1) steroids induce SEL and (2) steroids cause the growth of a pre-existing SEL, especially in obese children. Steroid-induced SEL (SSEL) is rarely described in children, with only six cases reported elsewhere. However, we have already reported four nephrotic children with SSEL, including one child in another hospital, in addition to the six cases. We investigated the frequency of SSEL in 125 children with renal diseases treated with glucocorticoids in a single hospital over 16 years, and examined the risk factors in 62 patients with SSEL reported in the literature. When patients complained of symptoms at the early stage of SSEL, i.e., back pain or numbness, and patients were obese, we performed spinal magnetic resonance imaging (MRI). SSEL was detected in 5 of 125 children (4.0%). Of the 5 patients with SSEL, 3 had vertebral compression fractures, and all 5 patients were on methylprednisolone pulse therapy. Our study suggests that many more patients can be detected at the early stage of SSEL by performing spinal MRI for patients with early symptoms, obesity, and those who have received methylprednisolone pulse therapy.

show abstract