Reversibility of lumbar epidural lipomatosis in obese patients after weight-reduction diet

Borstlap, A. C. W.; Rooij, W. J. J. van; Sluzewski, M.; Leyten, A. C. M.; Beute, GN

doi:10.1007/s002340050177

Cited by 16 publications

(35 citation statements)

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“…SEL is a condition wherein excess adipose tissue deposits around the thecal sac causing compression of neural structures 2,3,5,7,8,12,17,18,24,31,32) . In 1975, Lee et al 18) reported the first case of symptomatic epidural cord compression secondary to SEL.…”

Section: Discussionmentioning

confidence: 99%

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Idiopathic Thoracic Epidural Lipomatosis with Chest Pain

Lee

Park

Chang

et al. 2011

J Korean Neurosurg Soc

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was 22.8 kg/m 2 which was within the normal range. Neurologic examination revealed paresthesia on the left side, at the level of the T5 and T6 dermatomes, without myelopathy, motor weakness or claudication (Fig. 1). Hyperesthesia and allodynia were not evident. Laboratory evaluation, including full blood count, electrolytes, creatinine, liver function test, vitamin B12 and folate, urine analysis and culture, thyroid function tests, adrenocorticotropic hormone, and cortisol, were all unremarkable.Plain radiographs of the thoracic spine showed no abnormalities. Myelography computed tomography (CT) demonstrated a hypodense soft tissue mass within the posterior spinal canal and mainly in left vertebral foramen on T4/5 and 5/6 level ( Fig. 2).Magnetic resonance image (MRI) of the thoracic region presented a posterior compressing mass lesion of increased signal intensity on T1-weighted image (WI) and T2 WI in the epidural space, suggesting an epidural lipomatosis in the thoracic area. INTRODUCTIONSpinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components 5,12,13,25,26,32,34) . In cases without definite predisposing factors, the term 'idiopathic SEL' has been used. Idiopathic SEL in non-obese patients is exceptional 3,12,13,26) . According to previous reports, idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy 2,4,8,9,13,19) . To our knowledge, a thoracic radiculopathy due to idiopathic SEL has not been reported yet.We report a case of chest pain caused by idiopathic thoracic SEL in a female patient who did not have any other recognized predisposing factors for this condition. CASE REPORTA 16-year-old girl presented with a 2-month history of pain on her left chest. She reported that the pain spontaneously started around 2 months prior to admission and got worse over the two weeks. She could not do her usual daily living activities due to the intractable pain. She had no medical history for diabetes or steroid intake. On physical examination, her body weight was 55 kg and height was 155 cm, her body mass index Spinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components. Idiopathic SEL in non-obese patients is exceptional. Idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy. A thoracic radiculopathy due to idiopathic SEL has not been reported yet. We report a case of idiopathic SEL with intractable chest pain and paresthesia. We suggest that idiopathic SEL should be considered as a cause of chest pain.

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Section: Discussionmentioning

confidence: 99%

“…The treatment of SEL is a matter of debate, because many patients have been treated by simple weight reduction with good results 7,22,24) . However, this conservative treatment remains restricted to patients with mild neurological symptoms.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Thoracic Epidural Lipomatosis with Chest Pain

Lee

Park

Chang

et al. 2011

J Korean Neurosurg Soc

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“…Known predisposing factors are glucocorticoid therapy and Cushing's syndrome [5,6,14], while the idiopathic form has mostly been described in obese patients [6]. Our patient suffered from hyperlipidemia, but he neither showed abnormal fatty distribution at physical examination, nor he had impaired glucose tolerance, which has been reported together as predisposing factors in one patient with symptomatic epidural lipomatosis [15].…”

Section: Discussionmentioning

confidence: 52%

“…Spinal epidural lipomatosis (SEL) is characterized by an excessive deposit of fatty tissue in the epidural space [4]. Obesity and glucocorticoid use are known risk factors for SEL [5,6]. Herein, we describe the MR and pathological findings of a patient presenting with rapidly progressing paraplegia, which MR revealed to be due to spinal cord compression caused by a Staphylococcus aureus abscess in an epidural lipomatosis.…”

Section: Introductionmentioning

confidence: 99%

Acute spinal cord compression due to epidural lipomatosis complicated by an abscess: magnetic resonance and pathology findings

Zuccoli

Pipitone²,

Carli³

et al. 2010

Eur Spine J

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A 68-year-old male presented with rapidly progressive paraplegia. MR images of the thoracic spine were interpreted as being consistent with an abscess within an epidural lipomatosis compressing the spinal cord. Laminectomy was performed, and a large amount of pus was drained from the epidural lipomatosis, from which Staphylococcus aureus was isolated. This is the first reported case of an abscess involving an epidural lipomatosis.

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“…Fig. 1 a, b Myelography showing a dural sac compression particularly at the L5-S1 level Clinical improvement is reported after weight loss, but the reduction in epidural lipomatosis on nuclear magnetic resonance is reported in only a few cases [1,2]. Follow-up CT scan in our patient showed reduction in the accumulation of epidural adipose tissue around L4-L5 and L5-S1 after a weight loss of 17.5 kg, associated with disappearance of low back pain and improved walking distance.…”

Section: Discussionmentioning

confidence: 99%