Symptomatic epidural lipomatosis secondary to obesity. Case report

The authors present a case of thoracic spinal cord compression secondary to epidural lipomatosis in an obese patient. This patient represents the 10th case of epidural lipomatosis secondary to simple obesity reported in the literature. The diagnosis is based on three criteria: 1) medical history and physical examination consistent with segmental spinal cord compression; 2) epidural fat thickness greater than 7 mm in the region of compression, based on magnetic resonance imaging (preferred) or computerized tomographic imaging; and 3) a height-to-weight ratio greater than 27.5 kg/m2. This specific correlation between epidural fat thickness measurement and calculation of height-to-weight ratio has not previously been reported. Surgical decompression through a posterior laminectomy and excision of excess epidural fat resulted in immediate reversal of the patient's symptoms. Knowledge of the association of epidural lipomatosis with obesity in the absence of glucocorticoid imbalance is important in discerning what may be an underrecognized syndrome.