Myeloneuropathic Presentation of Spinal Epidural Lipomatosis

Abstract

Spinal epidural lipomatosis (SEL) is accumulation of unencapsulated fat tissue within the epidural space of the spinal canal. The most common cause of SEL is corticosteroid therapy, whereas most of the non-corticosteroid-dependent cases are idiopathic. If unrecognized, it may result in diagnostic confusion with other neuropathic or myelopathic conditions. We report 2 cases of SEL. The first case is of a 30-year-old man who received corticosteroid therapy for an acute and probably immune-mediated demyelinating process. Subsequently, the addition of compressive effects of SEL resulted in diagnostic confusion and initial workup at other centers for spinal cord malignancy and vascular malformation. The patient's symptoms improved after decompression surgery. The second case is of a 63-year-old woman with a history of type 1 diabetes mellitus that presented with increasing numbness in the lower extremities. She was initially diagnosed with diabetic neuropathy; however, the presence of myelopathic signs led to further investigation and diagnosis of SEL. Decompression surgery resulted in improvement of symptoms.

Spinal epidural lipomatosis in myeloma

“…The central canal of the thoracic spine is relatively small compared to the lumbar central canal, resulting in a smaller quantity of epidural fat resulting in earlier central canal stenosis [12]. The distribution of epidural fat in thoracic SEL involves the posterior epidural space, resulting in anterior thecal displacement, whereas lumbosacral SEL involves circumferential epidural fat accumulation, which compresses both the lumbar theca and radicular nerve roots [13]. An increase in epidural fat results in a loss of the posterior thecal convexity, which eventually results in effacement and obliteration of the subarachnoid space [14].…”