Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management

Abstract

Study Design:Narrative review of available literature.Objective:To summarize current trends in pathogenesis and management of spinal epidural lipomatosis (SEL) and suggest areas where more research would be of benefit.Methods:The available literature relevant to SEL was reviewed. PubMed, Medline, OVID, EMBASE, Cochrane, and Google Scholar were used to review the literature. Institutional review board approval is not applicable for this study.Results:This article clearly summarizes current trends in the pathogenesis and management of SEL.Conclusions:Possible etiologies of SEL include exogenous steroid use, endogenous steroid hormonal disease, obesity, surgery induced, and idiopathic disease. Comorbidities such as acquired immunodeficiency syndrome and Scheuermann’s disease have also been implicated in the pathogenesis of SEL. Steroid-induced SEL seems to have a proclivity for the thoracic region of the spine and has a higher incidence of paraplegia when compared with other forms. Several treatment modalities exist for SEL and are dictated by the underlying cause of the disorder. These include weight reduction, cessation of steroid medications, treatment of underlying endocrine abnormalities, and surgical decompression. Conservative treatments generally aim to decrease the thickness of adipose tissue in the epidural space, but the majority of patients tend to undergo surgical decompression to relieve neurologic symptoms. Surgical decompression provides a statistically significant reduction in symptoms, but postoperative mortality is high, influenced primarily by the patient’s preoperative comorbidities. Physicians should consider the underlying cause of SEL in a given patient before pursuing specific treatment modalities, but alarm symptoms, such as the development of acute cauda equina syndrome, should likely be treated with urgent surgical decompression.

Unilateral Pseudohypertrophy of Calf Muscles as a Clinical Manifestation of Lumbosacral Radiculopathy

“…Although not rare, SEL is usually underestimated because it is usually regarded as a benign radiologic finding. Despite that it is believed to be mainly associated with obesity and endocrinopathies, exogenous steroid injection is an important risk factor of SEL as seen in the present case [9]. Identifying the possible cause of SEL of the present case is beyond the scope of this report.…”

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

“…[ 4 , 7 ] Attempts at weight reduction and the management of low back pain failed to relieve his symptoms/signs; some studies, however, have shown that weight reduction may effectively manage symptomatic epidural lipomatosis. [ 2 ] Once the MR documented lumbar epidural lipomatosis with significant thecal sac compression L4–S2, the patient successfully underwent a decompressive laminectomy. [ 2 , 6 ]…”

Spinal epidural lipomatosis: a rare association of Cushing’s disease

“…MRI is the gold standard investigation as it can also visualise other pathologies such as compression fractures, osteoporosis and degenerative disc disease ( 7 ). Depending on the degree of spinal cord or nerve compression and presenting neurological symptoms SEL can be managed either surgically or conservatively.…”

“…Surgical management involves a decompressive laminectomy and excision of epidural adipose tissue. The main therapeutic approach for patients with endogenous steroid excess, as in our case, is treatment of the underlying disease, typically involving resection of the endocrine tumour to achieve eucortisolism ( 7 ). All seven previous cases of endogenous steroid excess treated with surgery to remove the primary tumour showed partial or complete resolution of neurological symptoms within 6 months.…”