Epidural lipomatosis in elderly patient: A rare cause of cauda equina compression

Abstract

Background: The most common cause of cauda equina compression in the elderly is lumbar spinal stenosis. Epidural lipomatosis is an additional known but rare cause of cauda equina compression readily diagnosed on MR studies. Notably, spinal canal decompression and direct excision of the epidural fat effectively manage this combined pathology. Case Description: A 70-year-old male presented with progressive truncal obesity associated with refractory lumbar neurogenic claudication. The lumbar magnetic resonance imaging (MRI) showed excessive epidural fat extending from L4 to S2 resulting in thecal sac compression; this was confirmed on the MRI myelogram study. Following a decompressive laminectomy, the patient’s cauda equina syndrome resolved. Conclusion: Recent weight gain with increased neurogenic claudication and the onset of a cauda equina syndrome may herald the presence of significant lumbar epidural lipomatosis. Here, laminectomy for excision of the excessive epidural fat resolved the patient’s symptomatic spinal stenosis.

Surgical management of thoracic myelopathy from long-segment epidural lipomatosis with skip hemilaminotomies: illustrative case

“…In both the thoracic and lumbar spine, laminoplasty, laminectomy, and fusion procedures have been described. 3,[30][31][32] Less invasive tissuepreserving decompression using endoscopic techniques has also been described. 10,33 Observations Given the patient's spinal cord compression spanning seven vertebral levels, an open surgical approach was recommended.…”

“…35 Reported outcomes after surgical treatment of SEL have ranged from moderate 9,32,34,36 to excellent. 3,10,18,[35][36][37][38][39][40][41] The reason for this variability is likely multifactorial. In this case, we presume that several factors contributed to the more modest neurological improvement.…”

“…1 The condition has been reported across broad age ranges spanning from neonates to octogenarians. 2,3 The prevalence rates of SEL are relatively low, with prior radiographic studies reporting rates between 2.5% and 6.3%. 4,5 When present, SEL is often an incidental, radiographic finding.…”

Spinal Epidural Lipomatosis: A Comprehensive Review

“…7,8 On rare occasions, cauda equina syndrome and acute paraplegia have been the presenting signs. 3,9,10 The wide range of symptoms is partly due to adipose accumulation in different regions of the spinal canal. 1 Symptoms may develop acutely; although, most cases develop over months to years.…”

“…2 Clinical presentation includes myelopathy, radiculopathy, neurogenic claudication, loss of sensation, difficulty voiding, lower extremity weakness, and rarely cauda equina syndrome. 3 The most common cause of SEL is long-term exogenous steroid therapy. SEL is also associated with obesity, overproduction of endogenous steroids, surgery, or deemed idiopathic.…”