Spinal Epidural Lipomatosis: a Case Report and Review of the Literature

Overview

Introduction Lumbar spinal epidural lipomatosis (SEL) is a rare condition defined by an excessive deposition of adipose tissue in the lumbar spinal canal. The objective of this case report is to document a clinical case of SEL presenting within a multidisciplinary spine clinic and to compare our clinical findings and management with the current literature. Case presentation A 51-year-old female presented at a spine clinic with low back pain, bilateral leg pain and difficulty walking. MR imaging of the lumbar spine showed L4-L5 and L5-S1 degenerative disk disease with evidence of severe central canal stenosis due to extensive epidural lipomatosis. The patient was initially advised to lose weight, undergo a course of physiotherapy, and consult with the pain clinic. Because of lack of improvement, the patient was scheduled for L4-S1 posterior spinal decompression and L4-L5 posterior spinal instrumented fusion. Discussion The discussion will include the diagnosis of SEL, imaging appearance, its risk factors, etiology and management. Conclusion This case report describes a case of lumbar spinal stenosis due to SEL with neurological symptoms. Some risk factors have also been identified in the literature. MRI is considered as the reference standard for its diagnosis. The therapeutic approach of patients with SEL is not standardized. Thus, reporting and investigating the diagnostic process and treatment of this patient will positively contribute to better management for other future patients.

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Cross-Sectional
  • Study Primary Completion Date: June 11, 2019

Interventions

  • Procedure: posterior spinal decompression and posterior spinal instrumented fusion
    • posterior spinal decompression and posterior spinal instrumented fusion performed on a patient with Spinal Epidural Lipomatosis

Clinical Trial Outcome Measures

Primary Measures

  • Low back pain
    • Time Frame: 3 months before surgery
    • Visual Pain Scale (0-10)
  • Low back pain
    • Time Frame: 6 weeks after surgery
    • Visual Pain Scale (0-10)
  • Distance Walking
    • Time Frame: 3 months before surgery
    • Distance walking (meter)
  • Distance Walking
    • Time Frame: 6 weeks after surgery
    • Distance walking (meter)
  • Low back pain
    • Time Frame: 3 months after surgery
    • Visual Pain Scale (0-10)
  • Low back pain
    • Time Frame: 1 year after surgery
    • Visual Pain Scale (0-10)
  • Distance walking
    • Time Frame: 3 months after surgery
    • Distance walking (meter)
  • Distance walking
    • Time Frame: 1 year after surgery
    • Distance walking (meter)

Participating in This Clinical Trial

Inclusion Criteria

  • Adults patient with a clinical diagnosis of Spinal Epidural Lipomatosis (MRI and clinical diagnosis) Exclusion Criteria:

  • Absence of clinical diagnosis of Spinal Epidural Lipomatosis

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: 100 Years

Investigator Details

  • Lead Sponsor
    • Canadian Memorial Chiropractic College
  • Provider of Information About this Clinical Study
    • Sponsor

References

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Fogel GR, Cunningham PY 3rd, Esses SI. Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J. 2005 Mar-Apr;5(2):202-11. doi: 10.1016/j.spinee.2004.05.252.

Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler AJ, Orgill DP; SCARE Group. The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 2018 Dec;60:132-136. doi: 10.1016/j.ijsu.2018.10.028. Epub 2018 Oct 18.

Fassett DR, Schmidt MH. Spinal epidural lipomatosis: a review of its causes and recommendations for treatment. Neurosurg Focus. 2004 Apr 15;16(4):E11.

Theyskens NC, Paulino Pereira NR, Janssen SJ, Bono CM, Schwab JH, Cha TD. The prevalence of spinal epidural lipomatosis on magnetic resonance imaging. Spine J. 2017 Jul;17(7):969-976. doi: 10.1016/j.spinee.2017.02.010. Epub 2017 Mar 3.

Yildirim B, Puvanesarajah V, An HS, Novicoff WM, Jain A, Shen FH, Hassanzadeh H. Lumbosacral Epidural Lipomatosis: A Retrospective Matched Case-Control Database Study. World Neurosurg. 2016 Dec;96:209-214. doi: 10.1016/j.wneu.2016.08.125. Epub 2016 Sep 5.

Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine J. 2019 Sep;9(6):658-665. doi: 10.1177/2192568218793617. Epub 2018 Aug 13.

Malone JB, Bevan PJ, Lewis TJ, Nelson AD, Blaty DE, Kahan ME. Incidence of spinal epidural lipomatosis in patients with spinal stenosis. J Orthop. 2017 Nov 6;15(1):36-39. doi: 10.1016/j.jor.2017.11.001. eCollection 2018 Mar.

Walchli B, Benini A. Spinal epidural lipomatosis. Swiss Med Wkly. 2001 Jun 16;131(23-24):359. doi: 10.4414/smw.2001.09739. No abstract available.

Ferlic PW, Mannion AF, Jeszenszky D, Porchet F, Fekete TF, Kleinstuck F, Haschtmann D. Patient-reported outcome of surgical treatment for lumbar spinal epidural lipomatosis. Spine J. 2016 Nov;16(11):1333-1341. doi: 10.1016/j.spinee.2016.06.022. Epub 2016 Jun 27.

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