Cauda equina syndrome secondary to idiopathic spinal epidural lipomatosis

Study Design. Three cases of idiopathic epidural lipomatosis are reported. Objectives. Description of the relationship between spinal pathologic overg rowth of fat tissue and neurologic symptoms. Summary of Background Data. Idiopathic epidural lipomatosis is a very rare condition; it is usually secondary to chronic steroid therapy or endocrinop athic diseases. Methods. Three men with a mean age of 58.5 years, who experienced intermitt ent claudication, bilateral radicular pain in both legs, and urinary dysfun ction with hypoesthesia in the perineal region, were evaluated by plain rad iography and magnetic resonance imaging, the results of which demonstrated a pathologic overgrowth of fat tissue in the spinal canal with a marked imp ingement of the dural sac. Obesity, endocrinopathic diseases, and chronic s teroid therapy were excluded for all patients. Surgical treatment was perfo rmed by wide multilevel laminectomies, fat debulking, and instrumented post erolateral fusion. Results. After surgery there was a gradual improvement in symptoms and sign s so that 2 years later the patients returned to daily activities and were neurologically normal. Conclusions. Spinal epidural lipomatosis can be a cause of back pain but ra rely radicular impingement. Magnetic resonance imaging is the procedure of choice. The treatment must be performed early by wide surgical decompressio n.