Acute Spinal Cord Injury Due to Epidural Lipomatosis Without Osseous Injury

Abstract

Spinal epidural lipomatosis (SEL) is a common pathology of the lumbar spine. While the natural history is not well understood, there is a strong association with metabolic syndrome and endocrine dysfunction. Clinical presentation typically involves slow, progressive onset of radicular and myelopathic symptoms. Treatment primarily consists of weight loss, while surgery is reserved for refractory cases or acute cauda equina syndrome. We present a case of acute spinal cord injury (SCI) after trauma with underlying SEL in the cervicothoracic spine. Additionally, a literature review using a MEDLINE search of the English literature through April 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed to identify all documented cases of acute spinal cord injury with underlying SEL. A 72-year-old obese male with insulin-dependent diabetes mellitus presented with subacute bilateral lower extremity weakness after a fall with a flank injury three days prior to evaluation. Within hours of admission, the patient acutely progressed to paraplegia and sensory loss below the T6 level consistent with an ASIA (American Spinal Injury Association) A spinal cord injury. No fracture or dislocation was identified on CT imaging. MRI of the thoracic spine revealed spinal cord compression secondary to extensive posterior epidural lipomatosis with resultant anterior displacement of the thecal sac. The patient underwent emergent T2-T9 laminectomy for decompression. Post-operatively, the patient regained sensation below the level of injury. A review of the literature reviewed no published articles on cases of complete spinal cord injury secondary to underlying SEL without associated fracture. Finally, we present the first report of an acute spinal cord injury in the setting of SEL without fracture. Our case demonstrates that SEL outside the lumbar spine confers increased risk for SCI following trauma. Patients with cervicothoracic SEL may require close neurological observation and timely surgical decompression.

Unilateral biportal endoscopy vs. open decompression for lumbar epidural lipomatosis-cohort study using a prospective registry

“…The LEL is a normal intraspinal fat space-occupying lesion caused by pathological hyperproliferation and accumulation of epidural fat ( 17 ). Because of stimulation or compression of the adjacent nerve root by abnormal hyperplasia of adipose tissue, patients often have a series of clinical symptoms, including lumbar pain, numbness, pain, and weakness of one or both lower limbs ( 2 , 3 , 17 ). Mild symptoms can be alleviated by conservative treatment; however, some patients often require surgical treatment when conservative treatment is ineffective.…”

“…The LEL can be idiopathic or secondary to Cushing's syndrome, obesity, or endocrine diseases, all of which are linked to excessive visceral fat accumulation ( 2 ). LEL is a rare disease in clinical practice; however, approximately 6% of symptomatic cases of lumbar spinal stenosis are associated with LEL ( 2 , 3 ). Clinical manifestations include nerve root and cauda equina compression injury symptoms, such as neurogenic claudication, loss of sensation, lower limb weakness, cauda equina syndrome, and so on ( 3 , 4 ).…”

“…LEL is a rare disease in clinical practice; however, approximately 6% of symptomatic cases of lumbar spinal stenosis are associated with LEL ( 2 , 3 ). Clinical manifestations include nerve root and cauda equina compression injury symptoms, such as neurogenic claudication, loss of sensation, lower limb weakness, cauda equina syndrome, and so on ( 3 , 4 ). If symptoms are mild, conservative treatment should be administered.…”

“…If symptoms are mild, conservative treatment should be administered. If the symptoms are severe combined with nerve or cauda equina compression symptoms, repeated conservative treatment is ineffective, or if the symptoms are progressively aggravated, surgical decompression is required ( 2 , 3 ).…”