Epidural lipomatosis with lumbar radiculopathy in one obese patient. Case report and review of the literature

Qasho, R.; Ramundo, O.E.; Maraglino, C; Lunardi, P; Ricci, Giovanna

doi:10.1007/bf01105566

Cited by 34 publications

(25 citation statements)

References 22 publications

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“…21,22,25 The treatment of SEL is a matter of debate, because many patients have been treated by simple weight reduction with good results. 3,[15][16][17] However, this conservative treatment remains restricted to patients with mild neurological symptoms. Surgery is often necessary in failed cases of weight reduction or in severely symptomatic patients.…”

Section: Discussionmentioning

confidence: 99%

Lumbar nerve root compression due to extradural, intraforaminal lipoma. An underdiagnosed entity?

Zevgaridis

Nanassis

Zaramboukas

2008

SPI

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Intraspinal extradural lipomas, not associated with spinal dysraphism, are rare lesions. True adult lipomas have to be distinguished from angiolipomas and from epidural lipomatosis. The authors report a unique case of a patient with unilateral lumbar nerve root compression caused by extradural, intraforaminal, true adult lipoma. A 62-year-old woman suffered severe left L-5 radiculopathy that progressively worsened during the 12 months prior to presentation. She did not experience improvement with conservative therapy. An MR imaging study of the lumbar spine revealed shifting of the left L-5 nerve root caused by a small extradural intrarecessal (that is, the beginning of the intravertebral foramen)/intraforaminal mass with MR imaging characteristics of fatty tissue. No other relevant intraspinal pathology could be identified. A left L4–5 fenestration was carried out. A small fatty intrarecessal/intraforaminal mass compressing severely the left L-5 root was identified and completely resected. The histological examination revealed a lipoma. The patient recovered completely and is fully mobile and symptom free 1 year after the operation. Intraspinal lipomas should be considered in cases of radiculopathy, especially in the absence of relevant degenerative or tumorous pathology and in the presence of nerve root shifting caused by fatty tissue.

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Section: Discussionmentioning

confidence: 99%

Lumbar nerve root compression due to extradural, intraforaminal lipoma. An underdiagnosed entity?

Zevgaridis

Nanassis

Zaramboukas

2008

SPI

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“…The relationship between LEL and obesity is well known and has been widely reported [3,8,20,26,28,29,30,32,35,37,38,39,40,41,42,43,44,45,46]. Some authors have documented the reversibility of LEL in obese patients after weight reduction [8,37,39].…”

Section: Lel and Obesitymentioning

confidence: 95%

“…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%

Lumbosacral epidural lipomatosis: MRI grading

Borré¹,

Borré²,

Aude³

et al. 2002

Eur Radiol

123

148

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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.

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“…Idiopathic spinal EDLis rare and only 26 cases have been reported (1). In most of cases the patients were obese men (1)(2)(3)(4)(5)(6). Epidural fat is usually thick on the outside of fractured vertebral bodies, and is frequently observed in patients with osteoporosis (3,4).…”

Section: Discussionmentioning

confidence: 99%

Cauda Equina Syndrome Caused by Idiopathic Sacral Epidural Lipomatosis.

et al. 2002

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The patient, whowas a non-obese woman with no predisposing conditions of lipomatosis, slowly developed cauda equina syndrome. Spinal magnetic resonance imaging (MRI) presented mass lesion of high intensity on Tlweighted image (WI) and an intermediate signal intensity in T2 WI in the epidural space of SI to coccyges. It has been reported that most idiopathic epidural lipomatosis (IEDL) is observed in obese men, and all cases have involved the thoracic or lumbar region. This is the first report of a patient with cauda equina syndrome caused by idiopathic sacral epidural lipomatosis (EDL). (Internal Medicine 41: 593-594, 2002)

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Epidural lipomatosis with lumbar radiculopathy in one obese patient. Case report and review of the literature

Cited by 34 publications

References 22 publications

Lumbar nerve root compression due to extradural, intraforaminal lipoma. An underdiagnosed entity?

Lumbar nerve root compression due to extradural, intraforaminal lipoma. An underdiagnosed entity?

Lumbosacral epidural lipomatosis: MRI grading

Cauda Equina Syndrome Caused by Idiopathic Sacral Epidural Lipomatosis.

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