Symptomatic Spinal Epidural Lipomatosis with Severe Obesity at a Young Age

Abstract

Symptomatic spinal epidural lipomatosis is a rare disorder characterized by overgrowth of fat in the extradural space. Most patients have an underlying endocrine disorder, such as Cushing's syndrome, or have taken exogenous steroids chronically. Although less common, obesity alone is thought to be a cause of spinal epidural lipomatosis, representing <25% of reported cases. Patients rarely become symptomatic before middle age without chronic exogenous steroid use. The usual clinical manifestations are similar to degenerative lumbar stenosis with neurogenic claudication, resulting in decreased walking and standing endurance with variable neurological deficits.This article describes 2 unique cases of spinal epidural lipomatosis, both in young patients with underlying morbid obesity who presented with acute progressive leg weakness and urinary retention. The patients had no underlying endocrinopathy, nor any history of exogenous steroid use. They underwent emergency laminectomy and removal of epidural fat, and histopathological examination confirmed the diagnosis of epidural lipomatosis. Postoperatively, the patients demonstrated significant improvement.We conducted a review of the available English literature and compared the age distribution in each group. Based on our review, our 2 patients are considerably younger than those in past reports, especially in the patient group to which the steroid was not administered. In addition, few cases exist of spinal epidural lipomatosis with acute sphincter dysfunction and paraparesis. Our cases suggest that morbid obesity can lead to juvenile spinal epidural lipomatosis with acute neurological changes.

Obesity and Chronic Pain

“…192 Obese patients are at risk for epidural lipomatosis from epidural injections. 193 Increased adipose tissue can distort the thecal sac and compress neural structures exiting the spinal cord. A review of 70 cases of epidural lipomatosis on magnetic resonance imaging and 34 randomly selected controls showed that the BMI was significantly elevated for the study group and revealed a strong correlation between the number of subsequent epidural corticosteroid injections and new occurrences of epidural lipomatosis.…”

The Influence of Obesity on the Outcome of Treatment of Lumbar Disc Herniation

“…O besity, commonly defined as a body mass index (BMI) of ‡30 kg/m 2 , affects one-third of the adult U.S. population, accounts for 10% of all U.S. health-care expenditures, and is associated with numerous clinical sequelae [1][2][3][4] . The impact of obesity on musculoskeletal and spinal disease, including low back pain, facet arthritis, and degenerative disc disease, has been well documented [5][6][7][8][9][10][11] . Although some studies have reported increased postoperative complications after spine surgery, multiple studies have demonstrated a beneficial effect from surgery on obese patients with the appropriate indications [12][13][14][15] .…”

Epidural lipomatosis with cauda equina syndrome in chronic alcoholic patient: A case report

“…In previous case reports, SEL was induced in most patients by steroids, obesity, or idiopathic causes [10], [11].…”