“Epidural lipomatosis is an uncommon medical disorder that is characterized by the suppression of the nerves or spinal cord due to the deposition of fat mass on or in the lining of the spinal cord in an abnormal amount.” It is also called spinal epidural lipomatosis (SEL).
Naturally, the spinal cord is covered or lined with a layer of epidural fat that provides protection. Due to certain reasons, the abnormal growth of this layer may occur leading to the excessive deposits of the fat masses on this spinal cord lining majorly in the lumbar or thoracic region. Around 58-61% of the cases may involve the thoracic region meanwhile, the other 39-42% may involve the lumbar region. Usually, these masses may extend to a thickness of more than 7mm.Epidural lipomatosis is more prevalent in men than women population.
Computed tomography (CT) and magnetic resonance imaging (MRI) is the most recommended techniques for the diagnosis of epidural lipomatosis. CT scan is generally performed before the MRI and it is expected to differentiate and explain the causes of compression as well, based on the density of the deposited masses. Simple X-rays are not recommended in this case as they cannot provide proper diagnosis and only helps in the exclusion of other reasons for back including tumors or degenerative diseases.
Epidural lipomatosis Symptoms
The symptoms of epidural lipomatosis may vary depending upon the extent of compression on the spinal cord caused due to the excessive deposition of fat in the epidural spaces as well as the area of occurrence. The most general symptoms may include;
- Severe back pain
- Numbness in the back
- The extensive weakness of the lower limbs (legs)
- Progressive damage to the spinal cord at a single or multiple points
- Pinpricking feelings leading to the tingling sensations may last longer
- Transformed reflexes are experienced that are maybe too fast or too slow in nature
- Loss of sensation is may be observed in some cases
- In some cases, the abnormality of function of bowel or urinary bladder is experienced
- Cauda equine syndrome or progressive compressive myelopathy is also experienced in some cases.
There are some other medical disorders such as; neoplasm, hemorrhage or infectionwhich may pose the same symptomology and mislead the diagnosis of the disease.
Epidural lipomatosis Causes
Epidural lipomatosis is a rare disorder whose underlying cause and the exact mechanism is not established yet. However, the following conditions can be considered for the occurrence of this disease, which may include;
Natural imbalance in the hormonal levels of the body preceding the enhanced production of hormones. The underlying causes for this imbalance can involve;
- Cushing syndrome and Cushing disease
- Pituitary prolactinoma
The prolonged administration of the steroidal therapies for various medical pathologies may lead to the formation of epidural lipomatosis. Steroidal therapies are considered as the major factor for this disease as it has been observed that approximately 3 out of 4 cases of epidural lipomatosismay possess this cause.
But there are few cases in which both of the above-stated conditions have not been found which leads the condition to further investigations to find the other causes proceeding this disease.
Epidural lipomatosis Disability
There are no proper shreds of evidence to demonstrate the relationship of this disease with disability. However, it is stated that the increased amount of epidural fat may lead to a better performance of physical activities such as stairs climbing in the older population. From many studies, it has been concluded that the epidural fat enhancement may play a protective role in this specified group of population.
Epidural lipomatosis Surgery
The choice of this treatment option depends upon the underlying cause, presentation and severity of the symptoms as well as the overall condition of the patient. In this regard, the most effective technique is decompressive laminectomy which involves the resection of the abnormal growths of the adipose tissues in the epidural spaces.Surgical treatment is a highly recommended technique among the patients who have a history of lower administration of steroidal therapies as it enhances the efficacy rate.
The overall surgical treatment outcomes and the postoperative management gets highly affected and complicated due to the other comorbidities and medical conditions of the patients. Therefore, this option is only reserved for the cases which may pose failure or resistance to the other treatments.
Epidural lipomatosis Alternative Treatment
There are two recommended therapeutic ways to treat the epidural lipomatosis which may include;
- Surgical treatment
- Conservative treatment
Regarding the conservative treatment, management of obesity (weight loss) and amputation of the steroidal therapies are considered to be very important and effective.
Weight loss strategy is recommended for only those patients who pose obesity as the underlying cause of their disease. Meanwhile, cutting off steroidal therapies for those patients who are administering these for chronic reasons is not a suitable choice as they may pose intolerance to this strategy. But those patients who do not have a history of steroidal therapies should be considered for endocrinological evaluation to determine the best possible reasons for the overproduction of hormones.