Initial Clinical Signs of Naka’s Grade III Lumbar Epidural Lipomatosis: A Case Series
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Published:
Feb 15, 2024
Keywords:
Lumbar epidural lipomatosis, low back pain, clinical signs
Main Article Content
Abstract
Introduction: Spinal epidural lipomatosis (SEL) is a rare pathology characterized by the overgrowth of nonencapsulated adipose tissue within the epidural space. This generates spinal stenosis, which might result in compression symptoms. The typical presentation is insidious pain that lasts months or years. The objective of this study was to carry out a descriptive analysis of the initial clinical signs of patients with Naka’s grade III lumbar SEL.
Materials and Methods: Retrospective observational study in the Spinal Pathology Unit of 4 institutions, from 2010 to 2023. Patients over the age of 18, of both sexes, who consulted for low back pain with or without radiation and presented Naka’s grade III lumbar lipomatosis on magnetic resonance imaging (MRI) were included.
Results: We included 40 patients, with a mean age of 62.5 years; 75% were obese, there were no smokers. The most frequent reason for consultation was low back pain, with a median duration of 5.5 months.
Conclusions: The most common reason for consultation was low back pain, with the exception of L3-S1 level involvement, which caused lumbar pain with radiation to the thigh. Patients with a longer period of pain (>6 months) were younger and had a lower BMI; although this was not statistically significant.
Materials and Methods: Retrospective observational study in the Spinal Pathology Unit of 4 institutions, from 2010 to 2023. Patients over the age of 18, of both sexes, who consulted for low back pain with or without radiation and presented Naka’s grade III lumbar lipomatosis on magnetic resonance imaging (MRI) were included.
Results: We included 40 patients, with a mean age of 62.5 years; 75% were obese, there were no smokers. The most frequent reason for consultation was low back pain, with a median duration of 5.5 months.
Conclusions: The most common reason for consultation was low back pain, with the exception of L3-S1 level involvement, which caused lumbar pain with radiation to the thigh. Patients with a longer period of pain (>6 months) were younger and had a lower BMI; although this was not statistically significant.
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How to Cite
Erausquin, T. I., Rosado Pardo, J. A., Vital, J. M., Sarotto, A. J., & Besse, M. (2024). Initial Clinical Signs of Naka’s Grade III Lumbar Epidural Lipomatosis: A Case Series. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(1), 6-14. https://doi.org/10.15417/issn.1852-7434.2024.89.1.1808
Section
Clinical Research
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References
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https://doi.org/10.1007/s00381-017-3706-5
13. López-González A, Resurrección Giner M. Idiopathic spinal epidural lipomatosis: urgent decompression in an
atypical case. Eur Spine J 2008;17 Suppl 2(Suppl 2):S225-S227. https://doi.org/10.1007/s00586-007-0465-0
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18. Fan CY, Wang ST, Liu CL, Chang MC, Chen TH. Idiopathic spinal epidural lipomatosis. J Chin Med Assoc
2004;67(5):258-61. https://pubmed.ncbi.nlm.nih.gov/15357116/
19. Badami JP, Hinck VC. Symptomatic deposition of epidural fat in a morbidly obese woman. AJNR Am J Neuroradiol 1982;3(6):664-5. https://pubmed.ncbi.nlm.nih.gov/6816044/
20. Ishikawa Y, Shimada Y, Miyakoshi N, Suzuki T, Hongo M, Kasukawa Y, et al. Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature. J Neurosurg Spine 2006;4(1):24-30. https://doi.org/10.3171/spi.2006.4.1.24
21. Naka N, Matsuoka T, Yamamoto K, Mitsuhashi K, Kawano J. Lumbar epidural lipomatosis: morphological
evaluation of epidural fat. Cent Jpn J Orthop Trauma 1998;41:327-8.
22. Park SK, Han JM, Lee K, Cho WJ, Oh JH, Choi YS. The clinical characteristics of spinal epidural lipomatosis in the
lumbar spine. Anesth Pain Med 2018;8(5):e83069. https://doi.org/10.5812/aapm.83069
23. Ge Y, Yang X, You Y, Xuan Y, Yan G. Comparison of relative and absolute values of magnetic resonance imaging in the diagnosis of spinal epidural lipomatosis. J Spinal Cord Med 2019;42(4):502-7.
https://doi.org/10.1080/10790268.2018.1449782
24. Ishihara S, Fujita N, Azuma K, Michikawa T, Yagi M, Tsuji T, et al. Spinal epidural lipomatosis is a previously
unrecognized manifestation of metabolic syndrome. Spine J 2019;19(3):493-500. https://doi.org/10.1016/j.spinee.2018.07.022
25. Al-Khawaja D, Seex K, Eslick GD. Spinal epidural lipomatosis--a brief review. J Clin Neurosci 2008;15(12):1323-
6. https://doi.org/10.1016/j.jocn.2008.03.001
2. Kuhn MJ, Youssef HT, Swan TL, Swenson LC. Lumbar epidural lipomatosis: the “Y” sign of thecal sac
compression. Comput Med Imaging Graph 1994;18(5):367-72. https://doi.org/10.1016/0895-6111(94)90007-8
3. Kim K, Mendelis J, Cho W. Spinal epidural lipomatosis: A review of pathogenesis, characteristics, clinical
presentation, and management. Global Spine J 2019;9(6):658-65. https://doi.org/10.1177/2192568218793617
4. Lee M, Lekias J, Gubbay SS, Hurst PE. Spinal cord compression by extradural fat after renal transplantation. Med J Aust 1975;1(7):201-3. https://doi.org/10.5694/j.1326-5377.1975.tb111328.x
5. Fassett DR, Schmidt MH. Spinal epidural lipomatosis: a review of its causes and recommendations for treatment. Neurosurg Focus 2004;16(4):E11. https://pubmed.ncbi.nlm.nih.gov/15191340/
6. Theyskens NC, Paulino Pereira NR, Janssen SJ, Bono CM, Schwab JH, Cha TD. The prevalence of spinal epidural
lipomatosis on magnetic resonance imaging. Spine J 2017;17(7):969-76. https://doi.org/10.1016/j.spinee.2017.02.010
7. Malone JB, Bevan PJ, Lewis TJ, Nelson AD, Blaty DE, Kahan ME. Incidence of spinal epidural lipomatosis in
patients with spinal stenosis. J Orthop 2017;15(1):36-9. https://doi.org/10.1016/j.jor.2017.11.001
8. Borré DG, Borré GE, Aude F, Palmieri GN. Lumbosacral epidural lipomatosis: MRI grading. Eur Radiol
2003;13(7):1709-21. https://doi.org/10.1007/s00330-002-1716-4
9. Roy-Camille R, Mazel C, Husson JL, Saillant G. Symptomatic spinal epidural lipomatosis induced by a longterm
steroid treatment. Review of the literature and report of two additional cases. Spine (Phila Pa 1976) 1991;16(12):1365-71. https://doi.org/10.1097/00007632-199112000-00004
10. Mallard F, Buni M, Nolet PS, Emary P, Taylor JA, Moammer G. Lumbar spinal epidural lipomatosis: A case report and review of the literature. Int J Surg Case Rep 2021;78:71-5. https://doi.org/10.1016/j.ijscr.2020.11.128
11. Quint DJ, Boulos RS, Sanders WP, Mehta BA, Patel SC, Tiel RL. Epidural lipomatosis. Radiology 1988;169(2):485-
90. https://doi.org/10.1148/radiology.169.2.3174998
12. Papastefan ST, Bhimani AD, Denyer S, Khan SR, Esfahani DR, Nikas DC, et al. Management of idiopathic spinal
epidural lipomatosis: a case report and review of the literature. Childs Nerv Syst 2018;34(4):757-63.
https://doi.org/10.1007/s00381-017-3706-5
13. López-González A, Resurrección Giner M. Idiopathic spinal epidural lipomatosis: urgent decompression in an
atypical case. Eur Spine J 2008;17 Suppl 2(Suppl 2):S225-S227. https://doi.org/10.1007/s00586-007-0465-0
14. Walker PB, Sark C, Brennan G, Smith T, Sherman WF, Kaye AD. Spinal epidural lipomatosis: A comprehensive
review. Orthop Rev (Pavia) 2021;13(2):25571. https://doi.org/10.52965/001c.25571
15. Fogel GR, Cunningham PY 3rd, Esses SI. Spinal epidural lipomatosis: case reports, literature review and metaanalysis. Spine J 2005;5(2):202-11. https://doi.org/10.1016/j.spinee.2004.05.252
16. Lisai P, Doria C, Crissantu L, Meloni GB, Conti M, Achene A. Cauda equina syndrome secondary to idiopathic
spinal epidural lipomatosis. Spine (Phila Pa 1976) 2001;26(3):307-9. https://doi.org/10.1097/00007632-200102010-00017
17. Robertson SC, Traynelis VC, Follett KA, Menezes AH. Idiopathic spinal epidural lipomatosis. Neurosurgery
1997;41(1):68-75. https://doi.org/10.1097/00006123-199707000-00015
18. Fan CY, Wang ST, Liu CL, Chang MC, Chen TH. Idiopathic spinal epidural lipomatosis. J Chin Med Assoc
2004;67(5):258-61. https://pubmed.ncbi.nlm.nih.gov/15357116/
19. Badami JP, Hinck VC. Symptomatic deposition of epidural fat in a morbidly obese woman. AJNR Am J Neuroradiol 1982;3(6):664-5. https://pubmed.ncbi.nlm.nih.gov/6816044/
20. Ishikawa Y, Shimada Y, Miyakoshi N, Suzuki T, Hongo M, Kasukawa Y, et al. Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature. J Neurosurg Spine 2006;4(1):24-30. https://doi.org/10.3171/spi.2006.4.1.24
21. Naka N, Matsuoka T, Yamamoto K, Mitsuhashi K, Kawano J. Lumbar epidural lipomatosis: morphological
evaluation of epidural fat. Cent Jpn J Orthop Trauma 1998;41:327-8.
22. Park SK, Han JM, Lee K, Cho WJ, Oh JH, Choi YS. The clinical characteristics of spinal epidural lipomatosis in the
lumbar spine. Anesth Pain Med 2018;8(5):e83069. https://doi.org/10.5812/aapm.83069
23. Ge Y, Yang X, You Y, Xuan Y, Yan G. Comparison of relative and absolute values of magnetic resonance imaging in the diagnosis of spinal epidural lipomatosis. J Spinal Cord Med 2019;42(4):502-7.
https://doi.org/10.1080/10790268.2018.1449782
24. Ishihara S, Fujita N, Azuma K, Michikawa T, Yagi M, Tsuji T, et al. Spinal epidural lipomatosis is a previously
unrecognized manifestation of metabolic syndrome. Spine J 2019;19(3):493-500. https://doi.org/10.1016/j.spinee.2018.07.022
25. Al-Khawaja D, Seex K, Eslick GD. Spinal epidural lipomatosis--a brief review. J Clin Neurosci 2008;15(12):1323-
6. https://doi.org/10.1016/j.jocn.2008.03.001