Spinal Epidural Lipomatosis

1. SPINAL EPIDURAL LIPOMATOSIS
Ade Wijaya, MD – November 2018

2. INTRODUCTION
• Rare
• Overgrowth of epidural adipose tissue within the spinal canal
• Often present with symptoms related to nerve or spinal cord
compression
• Steroids represent an important cause of spinal epidural lipomatosis
(SEL), with the first case of steroid-induced SEL after renal
transplantation being reported by Lee et al in 1975
Lee M, Lekias J, Gubbay SS, Hurst PE. Spinal cord compression by extradural fat after renal transplantation. Med J Aust. 1975;1: 201-203.

3. ETIOLOGY
• Exogenous steroid use (55,3 %)
• Endogenous steroid hormonal disease (3,2 %)
• Obesity (24,5 %)
• Surgery induced
• Idiopathic (17 %)
Fogel GR, Cunningham PY 3rd, Esses SI. Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J. 2005;5:202-211.

4. EXOGENOUS STEROID USE
• Most common and significant risk factor
• Enlarged preexisting adipose tissue
• Longterm use have been shown to increase the likelihood of developing SEL
• Acute onset of bilateral lower limb weakness after glucocorticoid treatment
for ulcerative colitis, implying that a patient’s sensitivity to steroid may also
play a role in the development of SEL in addition to treatment duration,
medication formulation, and cumulative dose
• The glucocorticoid receptor is observed in adipose tissue
• Treatment with testosterone and other anabolic steroids have been
associated with cases of SEL in the lumbar region without the use of
glucocorticoids
Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine Journal. 2018 Aug 13:2192568218793617.

5. ENDOGENOUS STEROID HORMONAL
DISEASE
• Hypothyroidism
• Cushing syndrome
• Carcinoid tumor
• Pituitary prolactinoma
Fassett DR, Schmidt MH. Spinal epidural lipomatosis: a review of its causes and recommendations for treatment. Neurosurg Focus. 2004;16:E11.
Koch CA, Doppman JL, Watson JC, Patronas NJ, Nieman LK. Spinal epidural lipomatosis in a patient with the ectopic corticotropin syndrome. N Engl J Med. 1999;341:1399-1400.
Bhatia K, Frydenberg E, Steel T, Ow-Yang M, Ho K, Grainger E. Spinal epidural lipomatosis due to a bronchial ACTH-secreting carcinoid tumour. J Clin Neurosci. 2010;17:1461-1462.

6. OBESITY
• Obesity are thought to cause a chronic inflammatory condition, which
may contribute to the overgrowth of adipose tissue in spinal canal
• Morbidly obese patients occasionally show a higher incidence of SEL
without exposure to steroid medications
• Furthermore, the incidence of SEL is increased in patients with high BMI
and triglyceride levels
Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine Journal. 2018 Aug 13:2192568218793617.

7. ASSOCIATED DISEASES AND THEIR
TREATMENT
• HIV +
• HAART treatment
• Scheuermann’s disease
• Androgen antagonist for prostate cancer
Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine Journal. 2018 Aug 13:2192568218793617.

8. CHARACTERISTICS
• M > F
• Steroid related SEL  thoracic
• Non-steroid SEL  lumbosacral
• Genetic variation may play a role in the pathogenesis of SEL
• Clinical presentation: spinal cord symptoms
Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine Journal. 2018 Aug 13:2192568218793617.

9. MRI

10. MANAGEMENT (CONSERVATIVE)
• Steroid cessation
• Weight reduction – manage obesity
• Treat the associated diseases if any
Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine Journal. 2018 Aug 13:2192568218793617.

11. MANAGEMENT (SURGICAL)
• 90 % needs surgical treatment
• Surgery is usually considered when clinical symptoms are acute and
severe or conservative treatments have failed
Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine Journal. 2018 Aug 13:2192568218793617.

12. SUMMARY
• Spinal epidural lipomatosis is a condition characterized by the
accumulation of excess adipose tissue in spinal canal, causing symptoms
associated with neurologic compression
• Steroids represent an important cause of spinal epidural lipomatosis
• Surgery is usually considered when clinical symptoms are acute and
severe or conservative treatments have failed (90% cases)

13. THANK YOU