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D’Agostino V, Petrera MR, Tedesco G, Pipola V, Ponti F, Spinnato P. Could Spinal Epidural Lipomatosis Be the Hallmark of Metabolic Syndrome on the Spine? A Literature Review with Emphasis on Etiology. Diagnostics (Basel) 2023; 13:diagnostics13020322. [PMID: 36673132 PMCID: PMC9858169 DOI: 10.3390/diagnostics13020322] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
Spinal epidural lipomatosis is defined by an excessive amount of epidural fat in the spinal canal, usually in the lumbosacral tract: a well-known cause of lumbar pain and spinal stenosis with a possible wide range of neurological symptoms. Recent research data reveal that, nowadays, obesity has become the main cause of spinal epidural lipomatosis. Moreover, this condition was recently recognized as a previously unknown manifestation of metabolic syndrome. Radiological studies (CT and MRI) are the only tools that are able to diagnose the disease non-invasively. Indeed, radiologists play a key role in disease recognition, with subsequent possible implications on patients' systemic health assessments. Despite its clinical importance, the condition is still underreported and neglected. The current literature review summarizes all the main etiologies of spinal epidural lipomatosis, particularly regarding its linkage with metabolic syndrome. An overview of disease characteristics from diagnosis to treatment strategies is also provided.
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Affiliation(s)
- Valerio D’Agostino
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Miriana Rosaria Petrera
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Tedesco
- Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Valerio Pipola
- Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: or
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Manjila S, Fana M, Medani K, Kay MD, Manjila R, Bazil TG, Udayasankar U. Spinal Epidural Lipomatosis Causing Lumbar Canal Stenosis: A Pictorial Essay on Radiological Grading and the Role of Bariatric Surgery Versus Laminectomy. Cureus 2022; 14:e26492. [PMID: 35919217 PMCID: PMC9339211 DOI: 10.7759/cureus.26492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Spinal epidural lipomatosis (SEL) is a rare condition characterized by an excessive accumulation of adipose tissue in the spinal canal that can have a compressive effect on intraspinal neuroanatomical structures, leading to clinical symptoms. Several different conservative and surgical treatment strategies have been proposed but the treatment and outcomes remain controversial. There is a lack of severity-based evidence documenting the success of decompressive laminectomy in SEL and there are only anecdotal reports of clinico-radiological success with weight loss from bariatric surgery. This article demonstrates the resolution of SEL in two patients with bariatric surgery with the help of pre and postoperative MR imaging. The authors also highlight the classic “types” of spinal epidural lipomatosis with a surgically relevant grading system and elucidate the existence of concurrent extraspinal lipomatosis (i.e. mediastinal and intra-abdominal lipomatosis), drawing parallels with the natural history of SEL. The controversial question remains whether a symptomatic SEL patient needs a multilevel laminectomy for spinal decompression or bariatric surgery that can indirectly help the spinal condition. We propose that bariatric intervention could be better frontline management in patients with multifocal/multisystem lipomatosis (i.e., combined spinal and extraspinal) and spinal decompression would be ideal for those SEL patients with coexisting bony and/or ligamentous spinal canal or foraminal stenosis. This manuscript serves as a comprehensive and contemporary update on the radiological profile and two plausible treatment paths and will look toward further verification by a randomized clinical trial.
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Spinnato P, Barakat M, Lotrecchiano L, Giusti D, Filonzi G, Spinelli D, Pipola V, Moio A, Tetta C, Ponti F. MRI Features and Clinical Significance of Spinal Epidural Lipomatosis: All You Should Know. Curr Med Imaging 2021; 18:208-215. [PMID: 34429050 DOI: 10.2174/1573405617666210824111305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/25/2021] [Accepted: 03/12/2021] [Indexed: 11/22/2022]
Abstract
Spinal epidural lipomatosis (SEL) is defined as the abnormal accumulation of unencapsulated adipose tissue in the spinal epidural space. SEL can be asymptomatic or can cause a wide range of symptoms, the most common of which is neurogenic claudication. Several other neurological manifestations may also occur, above all myelopathy and radicular symptoms. The spinal level most frequently involved in patients with SEL is the lumbar one, followed by the thoracic one. Imaging plays a key role in disease assessment. MRI is considered the most effective and sensitive modality for diagnosing and staging SEL. Anyway, also CT scan can diagnose SEL. The diagnosis may be incidental (in mild-moderate disease) or may be taken into account in cases with neurological symptoms (in moderate-severe disease). There are some recognized risk factors for SEL, the most common of which are exogenous steroid use and obesity. Recent studies have found an association between SEL and obesity, hyperlipidemia and liver fat deposition. As a matter of fact, SEL can be considered the spinal hallmark of metabolic syndrome. Risk factors control represents the initial treatment strategy in patients with SEL (e.g. weight loss, steroid therapy suspension). Surgical decompression may be required when conservative treatment fails or when the patient develops acute/severe neurological symptoms.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Massimo Barakat
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Ludovica Lotrecchiano
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Davide Giusti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | | | - Daniele Spinelli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Valerio Pipola
- Department of Oncologic and Degenerative Spine Surgery, IRCCS, Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Antonio Moio
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Cecilia Tetta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna. Italy
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Alsofyani MA, Alsalmi S, Malaekah H, Alharthi M, Bourghli A, Obeid I, Boissière L. Resolution of Idiopathic Epidural Lipomatosis after Bariatric Surgery: Case Report and Literature Review. Asian J Neurosurg 2021; 16:217-220. [PMID: 34211899 PMCID: PMC8202365 DOI: 10.4103/ajns.ajns_294_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/07/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022] Open
Abstract
Spinal epidural lipomatosis (SEL) is traditionally a rare disorder defined as an abnormal accumulation of unencapsulated epidural fat. SEL can be classified into idiopathic and secondary. We report a 46-year-old obese male with idiopathic epidural lipomatosis with a clinical picture of bilateral L5 and S1 radiculopathy, with an L5 and S1 distribution. Magnetic resonance imaging (MRI) showed epidural lipomatosis at L4, L5, and S1. After 2-year of sleeve gastrectomy, his bilateral sciatic radiculopathy disappeared, and updated MRI showed complete resolution of epidural lipomatosis. We present a case of an unusual epidural lipomatosis, resolved completely by bariatric surgery. This case report set out the effect of metabolic surgery on the local and systemic metabolic process.
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Affiliation(s)
- Mohammad A Alsofyani
- Department of Surgery, College of Medicine and University Hospital, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Sultan Alsalmi
- Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Haifaa Malaekah
- Department of Surgical, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdurrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Majed Alharthi
- Department of Surgical, Security Forces Hospital, Makkah, Kingdom of Saudi Arabia
| | - Anouar Bourghli
- Department of Orthopedic and Spinal Surgery, Kingdom Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim Obeid
- Department of Spine Surgery, Specialist Terrefort Clinic, Bruges, France
| | - Louis Boissière
- Department of Spine Surgery, Specialist Terrefort Clinic, Bruges, France
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Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine J 2019; 9:658-665. [PMID: 31448201 PMCID: PMC6693071 DOI: 10.1177/2192568218793617] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Narrative review of available literature. OBJECTIVE To summarize current trends in pathogenesis and management of spinal epidural lipomatosis (SEL) and suggest areas where more research would be of benefit. METHODS The available literature relevant to SEL was reviewed. PubMed, Medline, OVID, EMBASE, Cochrane, and Google Scholar were used to review the literature. Institutional review board approval is not applicable for this study. RESULTS This article clearly summarizes current trends in the pathogenesis and management of SEL. CONCLUSIONS Possible etiologies of SEL include exogenous steroid use, endogenous steroid hormonal disease, obesity, surgery induced, and idiopathic disease. Comorbidities such as acquired immunodeficiency syndrome and Scheuermann's disease have also been implicated in the pathogenesis of SEL. Steroid-induced SEL seems to have a proclivity for the thoracic region of the spine and has a higher incidence of paraplegia when compared with other forms. Several treatment modalities exist for SEL and are dictated by the underlying cause of the disorder. These include weight reduction, cessation of steroid medications, treatment of underlying endocrine abnormalities, and surgical decompression. Conservative treatments generally aim to decrease the thickness of adipose tissue in the epidural space, but the majority of patients tend to undergo surgical decompression to relieve neurologic symptoms. Surgical decompression provides a statistically significant reduction in symptoms, but postoperative mortality is high, influenced primarily by the patient's preoperative comorbidities. Physicians should consider the underlying cause of SEL in a given patient before pursuing specific treatment modalities, but alarm symptoms, such as the development of acute cauda equina syndrome, should likely be treated with urgent surgical decompression.
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Affiliation(s)
- Keonhee Kim
- Yonsei University, Seoul, Republic of Korea,Severance Hospital, Seoul, Republic of Korea
| | - Joseph Mendelis
- Albert Einstein College of Medicine, Bronx, NY, USA,Montefiore Medical Center, Bronx, NY, USA
| | - Woojin Cho
- Albert Einstein College of Medicine, Bronx, NY, USA,Montefiore Medical Center, Bronx, NY, USA,Woojin Cho, Montefiore Medical Center, Montefiore
Green Medical Arts Pavilion, 3400 Bainbridge Ave, 6th Floor, Bronx, NY 10467-2404, USA.
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Kellett CG, Siva V, Norman ICF, Jung J, Grahovac G, Minhas P. Symptomatic Idiopathic Spinal Epidural Lipomatosis in 9 Patients: Clinical, Radiologic, and Pathogenetic Features. World Neurosurg 2019; 126:e33-e40. [DOI: 10.1016/j.wneu.2019.01.098] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 12/27/2022]
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Smith MK, Martin R, Robblee J, Shore EM. A Case of Epidural Lipomatosis in Pregnancy: Management during Labour and Caesarean Section. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1182-1185. [PMID: 30007801 DOI: 10.1016/j.jogc.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/09/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Spinal epidural lipomatosis (SEL) is a rare condition of adipose tissue accumulation in the epidural space. As a result of excess adipose tissue, neuraxial anaesthesia has been reported to behave unpredictably in patients with this condition. CASE A 36-year-old woman had worsening postural headaches during pregnancy. MRI revealed SEL involving the thecal sac between L3/L4 and L5/S1. She had induction of labour but ultimately required a CS for delivery. Her anaesthesia was managed with an epidural inserted at L3/4. She developed a high block with relative sacral sparing. CONCLUSION Although neuraxial anaesthesia was thought to be contraindicated in patients with SEL, it can be done safely. Care must be taken to provide slow epidural titration to avoid high sensory block in patients with this condition.
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Affiliation(s)
| | - Rachel Martin
- Department of Anaesthesia, St. Michael's Hospital, Toronto, ON; Department of Anaesthesia, University of Toronto, Toronto, ON
| | - Jennifer Robblee
- Department of Neurology, Toronto Western Hospital, Toronto, ON; Department of Neurology, University of Toronto, Toronto, ON
| | - Eliane M Shore
- Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, ON; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON.
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Theyskens NC, Paulino Pereira NR, Janssen SJ, Bono CM, Schwab JH, Cha TD. The prevalence of spinal epidural lipomatosis on magnetic resonance imaging. Spine J 2017; 17:969-976. [PMID: 28263890 DOI: 10.1016/j.spinee.2017.02.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 02/09/2017] [Accepted: 02/28/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Spinal epidural lipomatosis (SEL) refers to an excessive accumulation of fat within the epidural space. It can be idiopathic or secondary, resulting in significant morbidity. The prevalence of SEL, including idiopathic and secondary SEL, and its respective risk factors are poorly defined. PURPOSE We sought to: (1) assess the prevalence of SEL among patients who underwent a dedicated magnetic resonance imaging (MRI) scan of the spine-including incidental SEL (ie, SEL without any spine-related symptoms), SEL with spine-related symptoms, and symptomatic SEL (ie, with symptoms specific for SEL); and (2) assess factors associated with overall SEL and subgroups. In addition, we assessed differences between SEL subgroups. METHODS We reviewed the records of 28,902 patients, aged 18 years and older with a spine MRI (2004 to 2015) at two tertiary care centers. We identified SEL cases by searching radiology reports for SEL, including synonyms and misspellings. Prevalence numbers were calculated as a percentage of the total number of patients. We used multivariate logistic regression analysis to identify factors associated with overall SEL and subgroups. RESULTS The prevalence of overall SEL was 2.5% (731 of 28,902): incidental SEL, 0.6% (168 of 28,902); SEL with symptoms, 1.8% (526 of 28,902); and symptomatic SEL, 0.1% (37 of 28,902). Factors associated with overall SEL in multivariate analysis were the following: older age (odds ratio [OR]: 1.01, 95% confidence interval [CI]: 1.01-1.02, p<.001), higher modified Charlson comorbidity index (OR: 1.10, 95% CI: 1.07-1.13, p<.001), male sex (OR: 2.01, 95% CI: 1.71-2.37, p<.001), BMI>30 (OR: 2.59, 95% CI: 1.97-3.41, p<.001), Black/African American race (OR: 1.66, 95% CI: 1.24-2.23, p=.001), systemic corticosteroid use (OR: 2.59, 95% CI: 1.69-3.99, p<.001), and epidural corticosteroid injections (OR: 3.48, 95% CI: 2.82-4.30, p<.001). CONCLUSIONS We found that about 1 in 40 patients undergoing a spine MRI had SEL; 23% of whom with no symptoms, 72% with spine-related symptoms, and 5% with symptoms specific for SEL. Our data help identify patients who might warrant an increased index of suspicion for SEL.
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Affiliation(s)
- Nina C Theyskens
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Nuno Rui Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
| | - Stein J Janssen
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Christopher M Bono
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Brigham and Women's Hospital-Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Thomas D Cha
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
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Beckworth WJ, McCarty EJ, Garcia-Corrada JE, Holbrook JF. Epidural Lipomatosis and Associated Spinal Stenosis-The Impact of Weight Loss: A Case Report. Am J Lifestyle Med 2017; 11:511-514. [PMID: 30202377 DOI: 10.1177/1559827616686764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lumbar stenosis is a common radiographic finding that sometimes can be symptomatic. It usually results from a degenerative process of hypertrophic facets, ligamentum flavum hypertrophy, and disc involvement. A prominence of fat in the epidural space, epidural lipomatosis, can also be a contributing factor. This case report presents a 55-year-old man with radiographic improvement of epidural lipomatosis and stenosis from dietary weight loss. Given the rising obesity epidemic, practitioners should be cognizant of epidural lipomatosis and consider weight loss as a possible treatment option.
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Affiliation(s)
- William J Beckworth
- Emory Spine Center, Atlanta, Georgia (WJB, JEG).,Emory Rehabilitation Department, Emory University, Atlanta, Georgia (EJM).,Emory Radiology, Division of Neuroradiology, Atlanta, Georgia (JFH)
| | - Erin J McCarty
- Emory Spine Center, Atlanta, Georgia (WJB, JEG).,Emory Rehabilitation Department, Emory University, Atlanta, Georgia (EJM).,Emory Radiology, Division of Neuroradiology, Atlanta, Georgia (JFH)
| | - Jose E Garcia-Corrada
- Emory Spine Center, Atlanta, Georgia (WJB, JEG).,Emory Rehabilitation Department, Emory University, Atlanta, Georgia (EJM).,Emory Radiology, Division of Neuroradiology, Atlanta, Georgia (JFH)
| | - John F Holbrook
- Emory Spine Center, Atlanta, Georgia (WJB, JEG).,Emory Rehabilitation Department, Emory University, Atlanta, Georgia (EJM).,Emory Radiology, Division of Neuroradiology, Atlanta, Georgia (JFH)
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Abstract
Peripheral nerve disorders are associated with all stages of HIV infection. Distal sensory polyneuropathy is characterised by often-disabling pain that is difficult to treat. It is prevalent in both high-income and low-income settings. In low-income settings, use of potentially neurotoxic antiretrovirals, which are inexpensive and widely available, contributes substantially to incidence. Research has focused on identification of factors that predict risk of distal sensory polyneuropathy and elucidation of the multifactorial mechanisms behind pathogenesis. Sensorimotor polyneuropathies and polyradiculopathies are less frequent than distal sensory polyneuropathy, but still occur in low-income settings and have potentially devastating consequences. However, many of these diseases can be treated successfully with a combination of antiretroviral and immune-modulating therapies. To distinguish between peripheral nerve disorders that have diverse, overlapping, and frequently atypical presentations can be challenging; a framework based on a clinicoanatomical approach might assist in the diagnosis and management of such disorders.
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Epidural lipomatosis causing new debilitating back pain in a patient with human immunodeficiency virus on highly active antiretroviral therapy. Int J Obstet Anesth 2012; 21:367-70. [DOI: 10.1016/j.ijoa.2012.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/29/2012] [Accepted: 06/07/2012] [Indexed: 11/23/2022]
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Abstract
Spinal epidural lipomatosis (SEL) is accumulation of unencapsulated fat tissue within the epidural space of the spinal canal. The most common cause of SEL is corticosteroid therapy, whereas most of the non-corticosteroid-dependent cases are idiopathic. If unrecognized, it may result in diagnostic confusion with other neuropathic or myelopathic conditions. We report 2 cases of SEL. The first case is of a 30-year-old man who received corticosteroid therapy for an acute and probably immune-mediated demyelinating process. Subsequently, the addition of compressive effects of SEL resulted in diagnostic confusion and initial workup at other centers for spinal cord malignancy and vascular malformation. The patient's symptoms improved after decompression surgery. The second case is of a 63-year-old woman with a history of type 1 diabetes mellitus that presented with increasing numbness in the lower extremities. She was initially diagnosed with diabetic neuropathy; however, the presence of myelopathic signs led to further investigation and diagnosis of SEL. Decompression surgery resulted in improvement of symptoms.
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Mackowiak PA, Garcia-Lazaro M, Cano A, Vidal E, Rivero A, Kindelan JM, Mackowiak PA. Pain in the Lower Limbs of a Patient with AIDS. Clin Infect Dis 2006. [DOI: 10.1086/499370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Schürmann D, Rademaker J, Trottenberg T, Bergmann F, Wesselmann H, Suttorp N. Spinal epidural lipomatosis: a manifestation of HAART-associated lipodystrophy. AIDS 2005; 19:2052-4. [PMID: 16260921 DOI: 10.1097/01.aids.0000191924.16561.ca] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vince GH, Brucker C, Langmann P, Herbold C, Solymosi L, Roosen K. Epidural spinal lipomatosis with acute onset of paraplegia in an HIV-positive patient treated with corticosteroids and protease inhibitor: case report. Spine (Phila Pa 1976) 2005; 30:E524-7. [PMID: 16135977 DOI: 10.1097/01.brs.0000176314.89648.78] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To report a case of HIV-related lipodystrophy with a rapid onset of symptoms from epidural lipomatosis in the wake of protease inhibitor and steroid treatment. SUMMARY OF BACKGROUND DATA Symptomatic spinal epidural lipomatosis is considered to be a rare condition usually presenting with slowly progressive cord or nerve root compression. Only 2 cases of spinal lipomatosis in HIV-related lipodystrophy have been reported. METHODS We describe the case of a 41-year-old male with HIV who received protease inhibitor medication and had neurologic deficits rapidly develop. RESULTS The patient had complete paraplegia develop within 12 hours from admission following a 1-day history of unsteady gait and a 3-day history of leg numbness. After diagnosis of epidural lipomatosis on magnetic resonance imaging, the patient underwent decompressive thoraco-laminectomy. He recovered well and was able to walk by postoperative day 4. CONCLUSION It is important to maintain an awareness for the possible association between HIV lipodystrophy and symptomatic epidural lipomatosis.
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Affiliation(s)
- Giles H Vince
- Department of Neurosurgery, Julius-Maximilians University, Wuerzburg, Germany.
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Resnick IB, Gomori JM, Kiselgoff D, Lossos A, Zilberman I, Miron S, Bitan M, Or R, Slavin S, Shapira MY. Spinal epidural lipomatosis following haploidentical allogeneic bone marrow transplantation for non-Hodgkin lymphoma. Clin Transplant 2005; 18:762-5. [PMID: 15516259 DOI: 10.1111/j.1399-0012.2004.00290.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Spinal epidural lipomatosis, is a very rare condition, usually seen as an uncommon complication of Cushing's syndrome secondary to chronic steroid therapy leading to increased fat deposits in the epidural space. CASE REPORT We report the first documented case of acute symptomatic spinal epidural lipomatosis in a patient with relapsed non-Hodgkin lymphoma. The patient underwent an allogeneic bone marrow transplantation (BMT) and a month of steroid treatment for acute graft vs. host disease (GvHD). He presented with a mild to moderate Cushing's syndrome and minimal obesity. He progressed rapidly to paraparesis, sensory deficit, urinary incontinence and finally respiratory arrest complicated with staphylococcal sepsis. CONCLUSION Epidural lipomatosis, with subacute thecal sac compression, is a possible life-threatening complication of relatively short-term systemic glucocorticoid therapy for GvHD in BMT setting.
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Affiliation(s)
- Igor B Resnick
- Department of Bone Marrow Transplantation and Cancer Immunotherapy, Hadassah University Hospital, Jerusalem, Israel.
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Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2002; 11:529-44. [PMID: 12426939 DOI: 10.1002/pds.662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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