From the Guidelines
Epidural lipomatosis is a condition characterized by excessive fat deposition in the epidural space of the spine, which can compress the spinal cord or nerve roots, leading to neurological symptoms. This condition is mentioned in the context of chronic or progressive myelopathy, where extrinsic compression of the spinal cord is a common cause, and epidural lipomatosis is one of the factors contributing to this compression, along with spinal degenerative changes, disc herniations, and malalignment 1. The symptoms and treatment approaches for epidural lipomatosis can vary, but it is often associated with long-term corticosteroid use, obesity, Cushing's syndrome, or hypothyroidism.
Some key points to consider about epidural lipomatosis include:
- It can occur anywhere along the spinal column, but it typically affects the thoracic and lumbar spine regions
- Symptoms can include back pain, leg weakness, numbness, tingling sensations, and in severe cases, bladder or bowel dysfunction
- Diagnosis typically involves MRI imaging, which clearly shows the characteristic excessive fat in the epidural space
- Treatment approaches depend on the underlying cause and symptom severity, ranging from conservative management to surgical decompression in cases with significant neurological impairment 1.
It is essential to recognize epidural lipomatosis early, as addressing the underlying cause can sometimes reverse the condition and prevent permanent neurological damage, thus prioritizing morbidity, mortality, and quality of life as the outcome.
From the Research
Definition and Characteristics of Epidural Lipomatosis
- Epidural lipomatosis is a rare condition characterized by the abnormal accumulation of unencapsulated epidural fat in the spinal canal, leading to compression of the neural elements 2, 3, 4.
- This condition can be caused by various factors, including exogenous steroid use, obesity, endogenous steroid hormonal disease, spine surgery, and idiopathic disease 2.
- The excess fat accumulation is typically localized to the thoracic and lumbar regions of the spine, and can lead to neurological deficits, myelopathy, radiculopathy, neurogenic claudication, and other symptoms 2, 4.
Risk Factors and Associations
- Exogenous steroid use is a commonly associated risk factor for epidural lipomatosis, with prolonged use increasing the risk of developing the condition 3, 5.
- Obesity and endogenous steroid hormonal disease are also associated with an increased risk of epidural lipomatosis 2, 4.
- Idiopathic cases of epidural lipomatosis have been reported, with no clear underlying cause or risk factor identified 4.
Clinical Presentation and Diagnosis
- Patients with epidural lipomatosis may present with progressive neurological deficits, including weakness, numbness, and difficulty walking 2, 4.
- Imaging studies, such as MRI or CT scans, are used to diagnose epidural lipomatosis and confirm the presence of excess epidural fat 3, 5.
- The clinical presentation and diagnosis of epidural lipomatosis can vary depending on the location and severity of the condition, as well as the underlying cause or risk factors 2, 4.