Epidural Lipomatosis: Causes, Symptoms, Treatment, Diagnosis

Epidural Lipomatosis is a pathological condition of the spine in which there is overgrowth of fatty tissue in and around the spine. This condition arises due to abnormal levels of fat which spread over a wide area especially in the spine. This distribution of fat is not in a specific pattern but is unevenly distributed.⁽¹⁾ These fatty tissues sometimes even invade the muscle tissues as well.

The main cause for Epidural Lipomatosis is believed to be excessive use of steroids resulting in abnormal levels of steroids in the body. This results in compression of the spinal cord causing a variety of neurological symptoms including pain, numbness, and tingling. The excessive use of steroids resulting in Epidural Lipomatosis may be due to some medical condition requiring excessive use of steroids.

Abnormal levels of steroids can also be produced within the body itself due to some health condition. There are also some cases where steroids are not responsible for development of Epidural Lipomatosis. These are called Idiopathic Epidural Lipomatosis. The elderly population is most likely to suffer from Epidural Lipomatosis. This condition can be treated both conservatively as well as surgically depending on the severity of the condition and the degree of stenosis caused by Epidural Lipomatosis.

What exactly causes Epidural Lipomatosis is not yet known, although Epidural Lipomatosis is associated with the following:

• Chronic steroid use which may be due to various medical conditions is a major contributor towards development of Epidural Lipomatosis
• Epidural Lipomatosis can also be caused due to increased production of hormones causing hormonal imbalances.⁽²⁾ This is mostly seen in medical conditions like Cushing Disease, obesity, and thyroid disorder causing Epidural Lipomatosis.

As stated, individuals with Epidural Lipomatosis have excessive fatty deposition in the epidural space which is the outermost layer of the spine resulting in compression of the spinal cord. The most common area where Epidural Lipomatosis occurs is the thoracic spine and the lumbar spine. This compression of the spine causes symptoms which are neurological in nature and include:

• Pain in the mid and lower back
• Numbness in the lower extremities
• Weakness of the lower extremities
• Tingling sensation in the lower extremities
• Abnormal reflexes
• Damage to the spinal cord
• Urinary or bowel incontinence in some cases.

In order to diagnose Epidural Lipomatosis, the treating physician will begin by taking a detailed history of the patient as to when the symptoms started and about any history of chronic steroid use. Once history taking is over, then a thorough physical examination is performed to look for areas of numbness and tingling and also signs of altered reflexes.

In case if Epidural Lipomatosis is suspected, then further investigations in the form of radiological studies of the spine in the form of x-rays, CT and MRI scans may be done.⁽³⁾ Myelography may also be done to see if there is any sort of compression of the spine caused by the fatty deposits.

Once fatty deposits are seen on the radiological studies, then a tissue biopsy of the fatty tissue is done where a tissue of the fatty deposit is taken and sent for analysis. The results of all these studies confirm the diagnosis of Epidural Lipomatosis.

As stated, Epidural Lipomatosis can be treated both conservatively as well as surgically. Conservative approaches to treat Epidural Lipomatosis may include use of medications that lower the steroid levels in the body thus reducing the buildup of fat around the epidural space of the spine. However, before going for this approach it is important to determine the cause of the steroid use, meaning the underlying condition for which the steroid was given in the first place.

If obesity is the cause of Epidural Lipomatosis then losing weight in a healthy manner is the best treatment approach to treat Epidural Lipomatosis. If there are abnormal levels of steroids produced in the body then finding the cause of this overproduction and treating it is the best way to treat Epidural Lipomatosis.

If conservative approaches fail to provide any relief of symptoms of epidural lipomatosis then the surgical options include a surgical procedure called decompressive laminectomy.⁽¹⁾ This procedure helps relieve pressure put on the spinal cord by the fatty tissue due to Epidural Lipomatosis and thus relieving the symptoms. This surgery is mostly done in patients who do not have a known cause for Epidural Lipomatosis and have severe symptoms due to this condition.

Postprocedure, the patient will have to undergo extensive physical therapy to improve strength and flexibility of the spine and reduce pain and discomfort. The patient will have to abstain from any heavy lifting or strenuous activity until the wound heals and the patient has gained enough strength of the spine. Diligent followups postsurgery and regular screenings are always recommended to see any signs of recurrence of Epidural Lipomatosis.

The prognosis of Epidural Lipomatosis depends on various factors and include

• The underlying cause of the condition
• The severity of the symptoms and the extent of damage to the spinal cord
• Overall health of the patient and the response of the patient to treatment

Epidural Lipomatosis is a condition which can be treated by both conservative and surgical approaches depending on the cause of t he condition and the severity of the symptoms. With diligent followups and close screenings an individual post treatment can be successfully treated from Epidural Lipomatosis.

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