[Lumbar epidural lipomatosis]

Spinal epidural lipomatosis is a pathological accommodation of fat tissue in the spinal canal. It seems to be a disease entity, which, though rare, has recently been diagnosed more frequently and can be accompanied by neurological deficits. The thoracic spinal canal is the preferred localization. Eighteen cases of symptomatic lumbar epidural lipomatosis have been described in the literature. We are reporting on our experience with another 8 patients. Three of these patients presented with the typical signs of spinal nerve irritation. In these cases epidural lipomatosis was associated with a small disk herniation without direct contact to the spinal nerve. Another 5 patients showed the clinical picture of a spinal claudication. In all 5 patients, there was a concentric compression of the thecal sac by epidural fat. In one patient, the cause of the lipomatosis was assumed to be long-term steroid therapy following kidney transplantation. Four patients suffered from extreme obesity. No cause for lipomatosis could be found in 3 patients. A microdiskektomy was performed in the 3 patients with the associated disk herniation; the remaining patients were treated conservatively. In 6/8 patients (3x surgery/3x diet), an "excellent" or "good" clinical result could be achieved after 1 year. Two patients had a "satisfactory" result. Lumbar epidural lipomatosis can be treated conservatively in cases with only mild neurological dysfunctions and known cause (e.g. obesity, steroid therapy). The surgical removal of associated disk herniation proved to be sufficient in cases described in this paper.