Spinal epidural lipomatosis

Case contributed by Yaïr Glick


Neuropathic back pain. Difficulty walking since the previous day.

Patient Data

Age: 75 years
Gender: Female

Extradural lipomatosis along the distal lumbar portion of the spinal canal, compressing the thecal sac, most prominent at the level of L5.
No evidence of significant disc bulge or herniation indenting the thecal sac or of osseous spinal stenosis.

Degenerative changes to the L5-S1 intervertebral disc, including thinning and vacuum phenomenon, accompanied by Modic type III endplate changes to the delimiting vertebrae. Mild bilateral foraminal narrowing at this level due to posterior disc bulge and hypertrophied ligamentum flavum.

Additional findings:
Peripelvic cysts in both kidneys.
Exophytic hypodense lesion in right kidney superior pole - cortical renal cyst, most probably.
Tiny calcific focus in each kidney - calculi? focal arterial calcifications?
Coarse atherosclerosis in the distal aorta and pelvic arteries.

Case Discussion

On gabapentin treatment for chronic (neuropathic?) back pain. "CT-proven" lumbar discopathy according to patient. Difficulty walking for past day, describes bilateral leg weakness.

Physical examination remarkable for a slightly wide based gait and mildly decreased anal sphincter tone.

CT lumbar spine showed a proliferation of epidural fat enveloping and compressing the thecal sac, which could explain the chronic back pain and perhaps the new mild symptoms as well.

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