Symptomatic Idiopathic Spinal Epidural lipomatosis in nine patients: clinical, radiological and pathogenetic features.

Symptomatic Idiopathic Spinal Epidural lipomatosis in nine patients: clinical, radiological and pathogenetic features.

World Neurosurg. 2019 Jan 29;:

Authors: Kellett CG, Siva V, Norman ICF, Jung J, Grahovac G, Minhas P

Abstract
BACKGROUND: Symptomatic spinal epidural lipomatosis (SSEL) is characterised by hypertrophy of adipose tissue within the spinal canal and consequent neural compromise. The exact pathogenesis remains enigmatic. The authors describe a retrospective case series, define the full clinical spectrum and discuss possible pathogenetic mechanisms.
METHODS: The medical notes and imaging of nine patients with SSEL undergoing surgery from 2008 - 2018 were analysed. Seven patients presented secondary to lumbosacral SEL; three patients with chronic incomplete CES and three patients with acute CES (including a 25-week gravid patient and a forty-year old patient with intravenous leiomyomatosis, both patients had mild SEL). In addition, two patients presented with progressive myelopathy secondary to thoracic SEL.
RESULTS: Patients presenting with acute CES had a mean age of 37 years (range 23-49 years) and mean extradural fat:spinal canal ratio of 47% (range 41-58%), in comparison to patients with chronic CES; mean age 61 years (range 58-65 years) and EF:SC ratio 72% (range 65 - 80%). Patients underwent laminectomy and resection of epidural fat at compressive levels. All patients with CES experienced complete resolution of symptoms at follow up (range 1 - 48 months).
CONCLUSION: The clinician should be astute to the radiological features of SEL, particularly in patients presenting with CES in the absence of acute disc herniation. The outcome of patients with CES and SEL following surgery is excellent regardless of symptom duration. Venous impedance related to increased BMI and EF deposition may play a predominant role in addition to mechanical compression in the pathogenesis of SSEL.

PMID: 30708081 [PubMed - as supplied by publisher]

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