SCI
Ryan M. Bloom, MD
Resident Physician
MedStar Health National Rehabilitation Hospital, Georgetown University School of Medicine
Washington, District of Columbia, United States
Oscar E. Dimant, MD
Attending Physician - Spinal Cord Injury
MedStar Health National Rehabilitation Hospital, Georgetown University School of Medicine
Washington, District of Columbia, United States
Ryan M. Bloom, MD
MedStar Health Georgetown University National Rehabilitation Hospital
Washington, District of Columbia, United States
Thoracic epidural lipomatosis with cord compression
Case Description:
36-year-old male with history of type 2 diabetes, BMI > 40 presented to acute care hospital for right foot wound, found to have necrotizing infection and osteomyelitis s/p right BKA. During admission, patient developed left lower extremity (LLE) weakness without saddle anesthesia, bladder or bowel involvement. CT lumbar spine with no acute bony abnormality. He was transferred to acute rehab 10 days later. On admission, exam notable for LLE weakness with spasticity in the adductor and quadriceps musculature concerning for myelopathy. Patient was transferred to the emergency department for cord compression MRI. Imaging showed concern for disc disease at T6-T7 with severe spinal canal stenosis, cord compression, and signal abnormality. He underwent T6-T8 laminectomy with intraoperative findings of a large thoracic epidural lipomatosis which was resected.
Discussions:
Spinal epidural lipomatosis (SEL) is overgrowth of epidural fat. SEL is associated with excess steroid exposure, obesity, diabetes, and hyperlipidemia. Pathology results from compression of surrounding neurologic structures. Clinical presentation can include myelopathy, radiculopathy, cauda equina syndrome, neurogenic claudication, or lower extremity weakness. MRI findings typically show a T1 and T2 hyper intense mass. Studies show SEL on approximately 2.5% of MRIs, with only 0.1% of all MRIs having findings attributable to SEL. Within this infrequent symptomatic group, progressive neurologic decline from SEL is even rarer. Treatment focuses on addressing underlying causes including weight loss, stopping steroid medications, treating endocrinopathies, and surgical decompression.
Conclusions:
Acute, severe SEL is a rare condition commonly affecting patients with obesity, diabetes, and dyslipidemia with frequency likely increasing given the rise of associated comorbidities. Presentation is nonspecific. Timely identification and management is key to prevent disease progression and preserve quality of life.
