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 overgrowth 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 endocrinopathic diseases.
Methods. Three men with a mean age of 58.5 years,
who experienced intermittent claudication, bilateral radicular pain in both legs, and urinary dysfunction with hypoesthesia in the perineal region, were evaluated by plain radiography and magnetic resonance imaging, the results of which demonstrated a pathologic overgrowth of fat tissue in the spinal canal with a marked impingement of
the dural sac. Obesity, endocrinopathic diseases, and
chronic steroid therapy were excluded for all patients.
Surgical treatment was performed by wide multilevel
laminectomies, fat debulking, and instrumented posterolateral fusion.
Results. After surgery there was a gradual improvement
in symptoms and signs 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 rarely radicular impingement.
Magnetic resonance imaging is the procedure of choice.
The treatment must be performed early by wide surgical decompression.