Epidural lipomatosis of the lumbar spine

Case contributed by Dr Michael Paks

Presentation

The patient presented with new urinary incontinence and acute on chronic lower back pain.

Patient Data

Age: 40 years

MRI lumbar spine

MRI
Circumferential prominence of epidural fat from L4-L5 with scalloping of the thecal sac is consistent with epidural lipomatosis. Combined with moderate-large disc bulge at L4/5 and L5/S1, this results in severe flattening and distortion of the thecal sac and obliteration of CSF around the cauda equina nerve roots. At L4/5, there is also moderate lateral recess stenosis bilaterally with compression of descending L5 nerve roots.

Case Discussion

The combination of epidural lipomatosis, moderate-large disc bulge and ligamentum flavum hypertrophy creates severe canal stenosis with severe flattening/distortion of the thecal sac with crowding and complete obliteration of CSF around the cauda equina nerve roots. The patient went on to have a decompressive lumbar laminectomy.

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