J Korean Neurosurg Soc.  2014 Jun;55(6):365-369. 10.3340/jkns.2014.55.6.365.

Spinal Epidural Lipomatosis in Korean

• Yoo JC
• Choi JJ
• Lee DW
• Lee SP

• KMID: 2191119
• DOI: http://doi.org/10.3340/jkns.2014.55.6.365

Abstract

Spinal epidural lipomatosis (SEL) is a rare disorder, regarded in literature as a consequence of administration of exogenous steroids, associated with a variety of systemic diseases, endocrinopathies and the Cushing's syndrome. Occasionally, SEL may occur in patients not exposed to steroids or suffering from endocrinopathies, namely, idiopathic SEL. Thus far, case studies of SEL among Korean have been published rather sporadically. We reviewed the clinical features of SEL cases, among Koreans with journal review, including this report of three operated cases. According to this study, there were some differences between Korean and western cases. Koreans had higher incidences of idiopathic SEL, predominant involvement in the lumbar segments, very few thoracic involvement and lower MBI, as opposed to westerners.

Keyword

Spinal epidural lipomatosis; Korean; Idiopathic

MeSH Terms

Cushing Syndrome
Humans
Incidence
Lipomatosis*
Steroids
Steroids

Figure

• 

  Fig. 1 A and B : Sagittal and axial T2WI MR show an abundance of epidural fat deposition with thecal compression from L1 to L5, resulting in obliteration of the thecal sac with an inverted star appearance. C : Multi-level laminotomy was performed on L1, L2, L3, L4, and L5. D : Postoperatively, the epidural fat was shown to be almost completely removed.

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  Fig. 2 A and B : Sagittal and axial T2-weighted MRI show an extensive epidural fat deposition with thecal compression from L1 to L5, showing 16 mm in the thickest lesion. C : Right L3 hemitotal laminectomy was performed and L4 total laminectomy with interbody fusion was performed on L4-5 to manage the underlying spinal stenosis. D : Postoperative MRI reveals much reduced epidural fat with decompression of the thecal sac.

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  Fig. 3 A and B : Sagittal and axial T2WI MR show an extensive epidural fat deposition with thecal compression from L2 to L4, especially in the anterior aspect of right L4 body. C : Right L4 hemi-laminectomy, L4-5 discectomy and debulking of the epidural fat, especially on the right anterior aspect of the L4 body were performed. D : The postoperative MRI reveals a greatly reduced epidural fat, distinctive visualization of the decompressed sacral sac, and L4 root.

Reference

1. Al-Khawaja D, Seex K, Eslick GD. Spinal epidural lipomatosis--a brief review. J Clin Neurosci. 2008; 15:1323–1326. PMID: 18954986.

2. Badami JP, Hinck VC. Symptomatic deposition of epidural fat in a morbidly obese woman. AJNR Am J Neuroradiol. 1982; 3:664–665. PMID: 6816044.

3. Chang H, Bahk WJ, Lim KH. Lumbar epidural lipomatosis. J Korean Soc Spine Surg. 1996; 3:256–251.

4. Choi KC, Kang BU, Lee CD, Lee SH. Rapid progression of spinal epidural lipomatosis. Eur Spine J. 2012; 21(Suppl 4):S408–S412. PMID: 21667131.

5. Choi SM, Choi G, Lee SH. Cauda equina syndrome due to spinal epidural lipomatosis. Korea J Spine. 2005; 2:65–67.

6. Choy WS, Kim HJ, Kim KH, Ong SS, Park JH. Lumbar epidural lipomatosis. J Korean Soc Spine Surg. 1998; 5:136–142.

7. Doo TH, Kim HJ, Shin DA. Lumbosacral epidural lipomatosis with compressive neuropathy. New Med J. 2006; 49:43–47.

8. Fan CY, Wang ST, Liu CL, Chang MC, Chen TH. Idiopathic spinal epidural lipomatosis. J Chin Med Assoc. 2004; 67:258–261. PMID: 15357116.

9. Fogel GR, Cunningham PY 3rd, Esses SI. Spinal epidural lipomatosis : case reports, literature review and meta-analysis. Spine J. 2005; 5:202–211. PMID: 15795966.

10. Haddad SF, Hitchon PW, Godersky JC. Idiopathic and glucocorticoid-induced spinal epidural lipomatosis. J Neurosurg. 1991; 74:38–42. PMID: 1984504.

11. Han YM, Ahn MS. Idiopathic spinal epidural lipomatosis. J Korean Neurosurg Soc. 2001; 30:795–799.

12. Ju WI, Ahn JG, Ji C, Park SC, Cho KS, Park CK, et al. Spinal epidural lipomatosis. J Korean Neurosurg Soc. 1999; 28:110–113.

13. Kawai M, Udaka F, Nishioka K, Houshimaru M, Koyama T, Kameyama M. A case of idiopathic spinal epidural lipomatosis presented with radicular pain caused by compression with enlarged veins surrounding nerve roots. Acta Neurol Scand. 2002; 105:322–325. PMID: 11939947.

14. Kim DY, Kim JW, Jeong JH, Choi JH. Symptomatic spinal epidural lipomatosis secondary to obesity. Kosin Med J. 2008; 23:111–113.

15. Kim HS, Han IH, Lee JH, Choi BK. Symptomatic spinal epidural lipomatosis induced by repeated epidural steroid injections. Korean J Spine. 2009; 6:218–220.

16. Kim IW, Koo CH, Park JS, Baek SU, Lee SD, Lee KH, et al. Adrenal cortical adenoma associated with spinal epidural lipomatosis and paraplegia. J Korean Pediatr Soc. 1986; 29:86–92.

17. Kim NG, Choi NC, Kwon OY, Jeon SC, Lim BH. A case of spinal epidural lipomatosis associated with phenytoin induced hypothyroidism and obesity. J Korean Neurol Assoc. 1997; 15:670–676.

18. Kim SY. Spinal epidural lipomatosis : a case report. Korean J Pain. 2009; 22:249–252.

19. Kim TW, Huh YS, Chi MP, Kim JO, Kim JC. Spinal epidural lipomatosis : report of four cases. J Korean Neurosurg Soc. 2000; 29:1527–1532.

20. Lee M, Lekias J, Gubbay SS, Hurst PE. Spinal cord compression by extradural fat after renal transplantation. Med J Aust. 1975; 1:201–203. PMID: 1092979.

21. Lee SB, Park HK, Chang JC, Jin SY. Idiopathic thoracic epidural lipomatosis with chest pain. J Korean Neurosurg Soc. 2011; 50:130–133. PMID: 22053234.

22. Lee SS, Ha GH, Yon JH, Son JY, Hong KH, Shin DY. Epidural lipomatosis discovered during managing of lower back pain : a case report. Korean J Anesthesiol. 1998; 35:381–384.

23. Min WK, Oh CW, Jeon IH, Kim SY, Park BC. Decompression of idiopathic symptomatic epidural lipomatosis of the lumbar spine. Joint Bone Spine. 2007; 74:488–490. PMID: 17681857.

24. Park GY, Cho JH, Lee SY. Lumbar spinal stenosis induced by epidural lipomatosis : a case report. J Korean Acad Rehabil Med. 2004; 28:618–621.

25. Park SH, Rho SW, Sung KH. Idiopathic spinal epidural lipomatosis. Korean J Spine. 2006; 3:99–101.

26. Robertson SC, Traynelis VC, Follett KA, Menezes AH. Idiopathic spinal epidural lipomatosis. Neurosurgery. 1997; 41:68–74. discussion 74-75. PMID: 9218297.

27. Seong BY, Park CJ, Park SJ, Kim SW, Lee TG. Lumbar spinal epidural lipomatosis : two cases report. J Korean Soc Spine Surg. 1998; 5:333–341.

28. Yim YB, Jo YJ, Kim DS, Jeong DS, Park KH, Song GS, et al. Idiopathic spinal epidural lipomatosis in a non-obese healthy man. J Korean Neurol Assoc. 1998; 16:402–407.