IDIOPATHIC SPINAL EPIDURAL LIPOMATOSIS

OBJECTIVE: Spinal epidural lipomatosis (SEDL) is a rare disorder often associated with the administration of exogenous steroids or the eleva tion of endogenous steroids. Spinal epidural lipomatosis develops in s ome patients in the absence of elevated steroid levels. The limited in formation known about idiopathic SEDL comes predominantly from isolate d case reports. We proposed to study our experience with idiopathic SE DL and to review the literature. METHODS: We identified eight symptoma tic patients with idiopathic SEDL treated at our institution, which is the largest series reported. AII patients were male and obese by body mass index (>27.5 kg/m(2)). The mean age of the patients was 35.4 yea rs. Idiopathic SEDL was equally distributed between the thoracic and l umbar spine. Six patients underwent laminectomy and fat debulking with good postoperative results; two patients were treated with a weight l oss diet, which resulted in the relief of symptoms after losing >15 kg each. RESULTS AND CONCLUSION: A review of our patients in conjunction with other reported cases reveals the following: 1) idiopathic SEDL o ccurs almost exclusively in the obese population; 2) idiopathic SEDL s eems to occur with equal frequency between the thoracic and lumber spi ne; 3) a strong male predominance exists; 4) thoracic SEDL presents at an earlier age compared with lumbar SEDL; 5) surgical decompression r emains the treatment of choice for the immediate relief of symptoms. O ur experience suggests that idiopathic epidural lipomatosis may be a p athological entity that has been underdiagnosed.