Can a lipoma cause spinal cord compression in an adult with no significant past medical history?

Can Lipomas Cause Spinal Cord Compression?

Yes, lipomas can definitively cause spinal cord compression in adults, though this is uncommon—lipomas represent less than 1% of all spinal cord tumors and typically present in pediatric populations, but adult cases with significant neurologic compromise are well-documented. 1

Types of Lipomas That Cause Spinal Cord Compression

Epidural Lipomatosis

• Epidural lipomatosis is characterized by increased accumulation of unencapsulated, histologically normal fat in the extradural space that can compress the spinal cord and cause neurologic deficits. 2
• This condition is strongly associated with chronic steroid use (5 of 6 patients in one surgical series) and represents a recognized cause of extrinsic spinal cord compression. 3, 2
• The American College of Radiology specifically lists epidural lipomatosis as a contributing factor to spondylotic myelopathy and chronic/progressive myelopathy. 3

Spinal Lipomas (Leptomyelolipoma/Lipomyelomeningocele)

• Leptomyelolipomas are congenital malformations where fatty subcutaneous masses extend into the vertebral canal and end as intramedullary spinal cord masses, causing compression through tethering and direct mass effect. 3, 4
• In a surgical series of 20 patients, 50% were adults over age 18, demonstrating that these lesions can present in adulthood despite being congenital. 4
• These lipomas produce sensory, motor, bowel, and bladder dysfunction with varying severity. 4

Isolated Intramedullary and Extradural Lipomas

• Nondysraphic intramedullary lipomas can occur in the cervical cord and cause significant compression, presenting with numbness, burning sensations, and myelopathic signs in adults. 1
• Epidural lipomas (also called angiolipomas due to intermixed vascular channels) are rare benign tumors that present as progressive spinal cord compression syndrome, typically with dorsal/radicular pain followed by progressive sensory loss and weakness. 5

Clinical Presentation in Adults

Progressive Neurologic Symptoms

• Adults typically present with progressive weakness, gait disturbance, sensory deficits, and bladder dysfunction when lipomas cause chronic compression. 6
• The most common initial symptom is local or radicular pain that precedes motor and sensory deficits. 5
• Symptoms can develop over months to years, distinguishing this from acute compression syndromes. 1, 5

Severity Spectrum

• Compression can range from mild sensory symptoms to severe myelopathy with respiratory compromise in extensive cases. 7
• The functional impact depends on the size, location, and degree of cord compression. 4

Diagnostic Approach

MRI is the Gold Standard

• MRI of the spine is the definitive imaging modality, demonstrating lipomas as T1 hyperintense, T2 hypointense, non-contrast-enhancing masses with superior soft-tissue resolution for evaluating the extent of cord compression. 6, 1
• The American College of Radiology emphasizes MRI's multiplanar capability makes it ideal for evaluating the spinal canal contents and surrounding structures. 3

Limitations of Other Modalities

• Myelography can be falsely normal in epidural lipomatosis (normal in 2 of 5 patients), whereas post-myelography CT revealed the fat accumulation in all cases. 2
• CT provides excellent bone detail but inferior soft-tissue characterization compared to MRI. 3

Treatment and Prognosis

Surgical Management

• Laminectomy with total or subtotal excision is the treatment of choice, with epidural lipomas being "one of the easiest tumours to remove of the spinal canal." 5
• For leptomyelolipomas, surgery aims to untether the conus medullaris, debulk the lipomatous mass, and reconstruct the dural canal. 4

Excellent Functional Outcomes

• No patients experienced neurological deterioration postoperatively in a 20-patient surgical series, with 67% showing dramatic improvement or becoming asymptomatic. 4
• Complete recovery can usually be achieved with epidural lipomas when diagnosed and treated appropriately. 5
• Subtotal resection is often sufficient and safer than attempting gross total resection, particularly for intramedullary lesions. 1, 7

Key Clinical Pitfalls

• Do not dismiss chronic progressive symptoms in adults as purely degenerative disease without MRI evaluation—lipomas are rare but treatable causes of myelopathy. 1, 5
• Normal myelography does not exclude epidural lipomatosis; proceed to MRI or post-myelography CT if clinical suspicion remains high. 2
• Early surgical intervention is critical to prevent irreversible neurological damage, as symptoms most resistant to correction include orthopedic deformities and bowel dysfunction. 4