gms | German Medical Science

Objective: Spinal epidural lipomatosis is an abnormal fat formation within the spinal canal. It is considered to be an infrequent cause of neurological symptoms. Most commonly it is associated with exogenous steroid administration or obesity. Treatment is controversially discussed and varies from weight reduction to open laminectomy.

Methods: We describe five cases of patients with clinical, radiological and intraoperative findings of bilateral multisegmental spinal epidural lipomatosis. In four obese patients (BMI >30kg/m²) without history of steroid medication and mild neurological symptoms lipomatoisis was localized in the lumbar spine. In these patients a microsurgical approach was performed including uni- or bilateral interlaminar fenestration and lateral recessus decompression. A younger patient with acute paraplegia due to lipomatosis at the middle thoracic level after long-term protease inhibitor and steroid medication recieved standard open laminectomy.

Results: In all cases of spinal epidural lipomatosis with slowly progressive symptoms we obtained very good results with a microsurgical approach. The patient with rapidly progressive paraplegia who underwent open laminectomy recoverd well after a few days.

Conclusions: Surgical treatment is apparently effective in therapy of spinal epidural lipomatosis. In case of acute neurological symptoms early intervention is required. Open laminectomy shows good results. In patients with mild neurological deficits conservative treatment may be an option. Microsurgical appraoch can be a favourable treatment alternative.