Lumbar laminotomy and replantation for the treatment of lumbar spinal epidural lipomatosis

Abstract

Rationale:Lumbar spinal epidural lipomatosis (SEL) is a rare condition characterized by excessive overgrowth of extradural fat within the lumbar spinal canal. Surgical decompression is commonly performed to treat symptomatic SELs. Fenestration or laminectomy with epidural fat debulking was a routine surgical procedure according to the literature, that may be causing postoperative lumbar instability. In the present study, we presented a brief report of lumbar SEL and introduced another surgical approach.Patient concerns:A 55-year-old man complained of severe low back pain and right leg radicular pain for a year, accompanied by neurogenic intermittent claudication. He received a variety of conservative treatments, including non-steroidal anti-inflammatory drugs, acupuncture, and physical therapy. However, his pain did not diminish. Finally, a posterior epidural mass in the dorsal spine extending from the L3 to L5 level, which caused dural sac compression was found on lumbar magnetic resonance imaging. This mass was homogeneously hyperintense in both T1W1 and T2W1 images, suggestive of epidural fat accumulation.Diagnoses:Lumbar SEL.Interventions:The patient underwent lumbar laminectomy, epidural fat debulking, and spinous process-vertebral plate in situ replantations.Outcomes:The patient presented with complete recovery of radiculopathy and low back pain after surgery. Postoperative magnetic resonance imaging showed that the increased adipose tissue disappeared, and the dural sac compression was relieved. A computed tomography scan revealed the lumbar lamina in situ. He was able to walk normally and remained relatively asymptomatic for 12 months after the operation at the last follow-up visit.Lessons:Lumbar laminotomy and replantation provide an ideal option to treat lumbar SEL because it can achieve sufficient and effective decompression, simultaneously reconstruct the anatomy of the spinal canal, and reduce the risk of iatrogenic lumbar instability.

Effects of LncRNA GAS5/miR-137 general anesthesia on cognitive function by TCF4 inflammatory bodies in patients undergoing lumbar spinal canal decompression

“…[ 19 ] With the intensification of population aging and the continuous change of lifestyle, its incidence has been increasing year by year, which seriously threatens people’s quality of life. [ 2 , 20 ] Currently, surgery is the main treatment for patients with lumbar spinal stenosis. [ 21 ] Moreover, we found that LncRNA GAS5 gene expression were up-regulated in patients undergoing lumbar spinal canal decompression.…”

“…[ 1 ] Compression of the spinal cord can cause such irreversible pathological changes as numbness of the lower limbs, weakness in walking, paralysis and incontinence of urine and feces, which seriously impacts the patients’ quality of life. [ 2 – 4 ]…”

“…[1] Compression of the spinal cord can cause such irreversible pathological changes as numbness of the lower limbs, weakness in walking, paralysis and incontinence of urine and feces, which seriously impacts the patients' quality of life. [2][3][4] Surgery is the main treatment for lumbar spinal stenosis, while epidural anesthesia and general anesthesia are the main intraoperative anesthesia methods. [5] However, there is some controversy about which anesthesia in conjunction with surgical treatment yields better results.…”

Surgical management of thoracic myelopathy from long-segment epidural lipomatosis with skip hemilaminotomies: illustrative case

“…In both the thoracic and lumbar spine, laminoplasty, laminectomy, and fusion procedures have been described. 3 , 30–32 Less invasive tissue-preserving decompression using endoscopic techniques has also been described. 10 , 33 …”

Percutaneous full-endoscopic uniportal decompression for the treatment of symptomatic idiopathic lumbar spinal epidural lipomatosis: Technical note

“…Surgery interventions should be considered when conservative treatments fail and clinical symptoms deteriorate rapidly ( 14 ). As for the surgical methods, extensive laminectomy and excision of the adipose tissue are the most commonly used options ( 15 ). So far, there has been no report to treat lumbar lipomatosis using the percutaneous uniportal full-endoscopic technique.…”