Feroze Shaheen, MD, Manjeet Singh, MD, Tariq Gojwari, MD,
Hamid Banday, DMRD, Mohd Farooq Mir, DNB,
Department of Radiodiagnosis, and
Mohammad Maqbool, MD, DM,
Department of Neurology, SK Institute of Medical Sciences, Soura,
Srinagar, Kashmir, India.
A 35-year-old nonsmoking, nonalcoholic man presented to the
neurology office with a 3-month history of signs and symptoms of
compressive myelopathy. The patient did not report any fever,
rigors, or chills. All baseline laboratory investigations were
unremarkable. The patient was not receiving any drugs except for
occasional painkillers. The patient was of average height and
weight for his age. A computed tomography (CT) scan was performed
(Figure 1), followed by magnetic resonance imaging (MRI) (Figures 2
Idiopathic epidural lipomatosis
The patient is on neurology follow-up and has been put on weight
Plain CT of the dorsolumbar spine revealed an extradural
fat-density mass at multiple levels compressing the spinal cord.
The vertebral bodies and posterior arches were normal. No
paravertebral mass or collection was seen (Figure 1).
MRI was then performed. T1- and T2- weighted images of the
dorsolumbar spine revealed a multisegmental extra dural
hyperintensemass, with compression of posterior dorsolumbar thecal
sac. The spinal cord showed normal signal intensity and morphology
(Figures 2 and 3). There was no evidence of any vertebral or
intervertebral hyperintensity or paravertebral collection.
Epidural lipomatosis is an uncommon disorder defined as a
pathologic overgrowth of normal epidural fat.1-4 It is
more often associated with the administration of exogenous steroid
with variable duration and doses1,2,4-7 and can also be
seen in patients with endogenous steroid overproduction, obesity,
or idiopathic disease.3,6,7 Furthermore, it may occur in
some patients in the absence of exposure to steroids but is
generally associated with obesity. Whatever the predisposing
factor, the majority of these patients are men. It can lead to the
development of spinal cord or radicular compression and can be the
cause of back pain.1,8 It is a rare cause of
paraparesis.7 The number of involved vertebral levels
and obesity are strongly correlated, whereas severity of dural
compression is not always significantly associated with
neurological complications. This indicates that epidural fat of the
lumbar spine contributes to neurological deficits.9 Most
cases of epidural lipomatosis associated with corticosteroid use
occur in the thoracic region, while most idiopathic cases occur in
the lumbar region.1
The diagnosis of epidural lipomatosis can be established by
myelography, CT, and MRI. MRI is considered to be the imaging
procedure of choice,1,8,9 allowing an assessment of the
extent of lipomatosis and allowing (as CT does also) an
identification of the lipomatous tissue.1 MRI-based
grading is helpful for the diagnosis and evaluation of this
The most common treatment for epidural lipomatosis associated
with corticosteroid use consists of surgical
decompression.1,8,2,10 Medicaltreatment includes
corticosteroid withdrawal and weight reduction.1,3,9
Treatment for idiopathic epidural lipomatosis is more often
The pathogenesis of epidural lipomatosis remains unknown, but
some hypotheses suggest a metabolic disorder as the underlying
cause.1 With increased awareness of this condition and
with improved imaging techniques, further studies of this disease
should be undertaken.7
Idiopathic epidural lipomatosis is a rare cause of spinal cord
compression. Since most patients respond to conservative
management, an exact diagnosis is very important. MRI is the
modality of choice for the diagnosis and follow-up of these
- Levy-Weil FE, Feldmann JL. Epidural lipomatosis [in French].
Presse Med. 2000;29:469-475.
- Chen CC, Lee WY, Cho DY. Spinal epidural lipomatosis.
Zhonghua Yi Xue Za Zhi (Taipei). 2002; 65(2):86-89.
- Fassett DR, Schmidt MH. Spinal epidural lipomatosis: A review
of its causes and recommendations for treatment. Neurosurg
- Fan CY, Wang ST, Liu CL, et al. Idiopathic spinal epidural
lipomatosis. J Chin Med Assoc. 2004;67: 258-261.
- Dudek H, Michno T, Michalski J. Idiopathic epidural lipomatosis
of the vertebral canal [in Polish]. Neurol Neurochir Pol.
- Fogel GR, Cunningham PY 3rd, Esses S. Spinal epidural
lipomatosis: Case reports, literature review and meta-analysis.
Spine J. 2005;5:202-211.
- Shah JA, Flynn P, Choudhari KA. Idiopathic spinal epidural
lipomatosis. Br J Neurosurg. 2005;19:265-267.
- Lisai P, Doria C, Crissantu L, et al. Cauda equina syndrome
secondary to idiopathic spinal epidural lipomatosis.
- Ishikawa Y, Shimada Y, Miyakoshi N, et al. Decompression of
idiopathic lumbar epidural lipomatosis: Diagnostic magnetic
resonance imaging evaluation and review of the literature.J
Neurosurg Spine. 2006;4:24-30.