LUMBAR EPIDURAL LIPOMATOSIS

Spinal epidural lipomatosis is a pathological accomodation of fat tiss ue in the spinal canal. It seems to be a disease entity, which, though rare, has recently been diagnosed more frequently and can be accompan ied by neurological deficits. The thoracic spinal canal is the preferr ed localization. Eighteen cases of symptomatic lumbar epidural lipomat osis have been described in the literature. We are reporting on our ex perience with another 8 patients. Three of these patients presented wi th the typical signs of spinal nerve irritation. In these cases epidur al lipomatosis was associated with a small disk herniation without dir ect contact to the spinal nerve. Another 5 patients showed the clinica l picture of a spinal claudication. In all 5 patients, there was a con centric compression of the thecal sac by epidural fat. In one patient, the cause of the lipomatosis was assumed to be long-term steroid ther apy following kidney transplantation. Four patients suffered from extr eme obesity. No cause for lipomatosis could be found in 3 patients. A microdiskektomy was performed in the 3 patients with the associated di sk herniation; the remaining patients were treated conservatively. In 6/8 patients (3x surgery/3x diet), an ''excellent'' or ''good'' clinic al result could be achieved after 1 year. Two patients had a ''satisfa ctory'' result. Lumbar epidural lipomatosis can be treated conservativ ely in cases with only mild neurological dysfunctions and known cause (e.g. obesity, steroid therapy). The surgical removal of associated di sk herniation proved to be sufficient in cases described in this paper .