Spinal epidural lipomatosis following bilateral spinal decompression surgery

Greenish, Davyd; Watura, Karen; Harding, Ian

doi:10.1136/bcr-2018-226985

Cited by 11 publications

(13 citation statements)

References 11 publications

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“…Pre-operative MRI spine had not revealed SEL. They could not provide an explanation but recommended this to be included in the recognised post-operative complications of spinal surgery ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

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

Ahmad

Best

Lansdown

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Summary Excess cortisol is associated with hypertrophy and redistribution of adipose tissue leading to central obesity which is classically seen in Cushing’s syndrome. Abnormal accumulation of fatty tissue in the spinal canal is most commonly associated with chronic steroid therapy and rarely reported with endogenous Cushing’s syndrome. Herein, we describe a case of spinal epidural lipomatosis (SEL) associated with Cushing’s disease. A 17-year-old man was referred with lower limb weakness, weight gain, multiple stretch marks, back pain and loss of height. He had clinical and biochemical features of Cushing’s syndrome. MRI and Inferior Petrosal Sinus Sampling (IPSS) confirmed a pituitary adenoma as the source. On day 1 post trans-sphenoidal adenectomy he developed spastic paraparesis with a sensory deficit to the level of T5. MRI spine showed increased fat deposition in the spinal canal from T2 to T9 consistent with a diagnosis of SEL. He was managed conservatively and made a good recovery following restoration of eucortisolism and a period of rehabilitation. Learning points: SEL is a serious complication of glucocorticoid excess and should be considered in any patient presenting with new lower limb neurological symptoms associated with hypercortisolism. It is important to distinguish symptomatic SEL from cortisol-induced proximal myopathy by good history and clinical examination. MRI of the spine is the gold standard investigation for making a diagnosis of SEL. Restoration of eucortisolism can lead to resolution of fat accumulation and good neurological outcome.

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Section: Discussionmentioning

confidence: 99%

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

Ahmad

Best

Lansdown

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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“…1 Symptoms may develop acutely; although, most cases develop over months to years. [11][12][13] Praver et al found that higher severity of presenting symptoms was associated with a greater likelihood of delayed recovery. 14…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Greenish et al reported a case of SEL acutely after spinal canal decompression surgery at L4/L5. 11 The patient initially presented with claudication and bilateral leg pain, which resolved immediately after surgery and led to early discharge. 11 Two days later, the patient re-presented with difficulty walking and bilateral leg pain.…”

Section: Spine Surgerymentioning

confidence: 99%

“…11 The patient initially presented with claudication and bilateral leg pain, which resolved immediately after surgery and led to early discharge. 11 Two days later, the patient re-presented with difficulty walking and bilateral leg pain. A clinical diagnosis of an epidural hematoma was considered; however, postoperative MRI showed an accumulation of epidural fat at L5/S1, which was not present pre-operatively.…”

Section: Spine Surgerymentioning

confidence: 99%

“…A clinical diagnosis of an epidural hematoma was considered; however, postoperative MRI showed an accumulation of epidural fat at L5/S1, which was not present pre-operatively. 11 The patient underwent a decompression of L5/S1 for SEL, with no signs of disease at three weeks and a five-month follow-up. Another account of rapidly progressive SEL was reported by Youn et al in a 67-year-old man.…”

Section: Spine Surgerymentioning

confidence: 99%

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Spinal Epidural Lipomatosis: A Comprehensive Review

et al. 2021

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Outcome of posterior decompression for spinal epidural lipomatosis

Schmutzer-Sondergeld,

Zimmermann,

Trabold

et al. 2023

Acta Neurochir

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Background In contrast to osteoligamentous lumbar stenosis (LSS), outcome of surgical treatment for spinal epidural lipomatosis (SEL) is still not well defined. We present risk factors for SEL and clinical long-term outcome data after surgical treatment for patients with pure SEL and a mixed-type pathology with combined SEL and LSS (SEL+LSS) compared to patients with pure LSS. Methods From our prospective institutional database, we identified all consecutive patients who were surgically treated for newly diagnosed SEL (n = 31) and SEL+LSS (n = 26) between 2018 and 2022. In addition, a matched control group of patients with pure LSS (n = 30) was compared. Microsurgical treatment aimed for posterior decompression of the spinal canal. Study endpoints were outcome data including clinical symptoms at presentation, MR-morphological analysis, evaluation of pain-free walking distance, pain perception by VAS-N/-R scales, and patient’s satisfaction by determination of the Odom score. Results Patients with osteoligamentous SEL were significantly more likely to suffer from obesity (body mass index (BMI) of 30.2 ± 5.5 kg/m2, p = 0.03), lumbar pain (p = 0.006), and to have received long-term steroid therapy (p = 0.01) compared to patients with SEL+LSS and LSS. In all three groups, posterior decompression of the spinal canal resulted in significant improvement of these symptoms. Patients with SEL had a significant increase in pain-free walking distance during the postoperative course, at discharge, and last follow-up (FU) (p < 0.0001), similar to patients with SEL+LSS and pure LSS. In addition, patients with pure SEL and SEL+LSS had a significant reduction in pain perception, represented by smaller values of VAS-N and -R postoperatively and at FU, similar to patients with pure LSS. In uni- and multivariate analysis, domination of lumbar pain and steroid long-term therapy were significant characteristic risk factors for SEL. Conclusions Surgical treatment of pure SEL and SEL+LSS allows significant improvement in pain-free walking distance and pain perception immediately postoperatively and in long-term FU, similar to patients with pure LSS.

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Spinal epidural lipomatosis following bilateral spinal decompression surgery

Cited by 11 publications

References 11 publications

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

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

Spinal Epidural Lipomatosis: A Comprehensive Review

Outcome of posterior decompression for spinal epidural lipomatosis

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