Session Title: AA 2021 Virtual Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Theodora L. Swenson, MD: No financial relationships or conflicts of interest
Case Diagnosis: Patient presented with a 3-year history of neurogenic claudication and was found to have epidural lipomatosis in the L5-S1 region
Case Description: A 73-year-old female with a history of CKD III, HTN, HLD presented to spine clinic with a 3-year history of right greater than left buttock pain. The pain radiated down the back of her right thigh to her ankle and down the back of her left leg to her posterior knee. Pain was aggravated by walking, and she could only walk 200 yards before developing symptoms. She had received multiple lumbar injections, including L5-S1 epidural steroid injection, L4-5 and L5-S1 facet joint injections, medial branch blocks and RFAs with no relief. Rest and anti-inflammatories helped but dosage was limited by her kidney disease. She denied a history of steroid use, and her BMI was 24.
Setting: Outpatient spine clinicAssessment/
Results: Spinal epidural lipomatosis is a relatively rare condition characterized by overgrowth of adipose tissue within the spinal canal. Patients often present with symptoms of nerve or cord compression, including radiculopathy, myelopathy, and claudication. On MRI, the dural sac can appear narrowed and resemble a “Y” shaped configuration. Surgery is reserved for patients with severe symptoms who fail conservative treatment.
Discussion: On exam, she had five out of five strength throughout and sensation was intact bilaterally. Reflexes were 2+ and symmetric. Hip exam and SI joint provocative maneuvers were negative. MRI was notable for a L4-5 mild left disc bulge with bilateral facet arthropathy, mild central canal stenosis, and moderate left lateral recess stenosis. On review of the imaging, it was also noted that epidural lipomatosis was seen predominantly in the L5-S1 region.
Conclusion: Spinal epidural lipomatosis should be considered on the differential for patients with neuro-claudicatory symptoms. Steroid use, obesity, and idiopathic causes of spinal epidural lipomatosis exist.
Level of Evidence: Level V
To cite this abstract in AMA style:Swenson TL. Idiopathic Spinal Epidural Lipomatosis in a Non-Obese Patient with No History of Steroid Use [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/idiopathic-spinal-epidural-lipomatosis-in-a-non-obese-patient-with-no-history-of-steroid-use/. Accessed December 3, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/idiopathic-spinal-epidural-lipomatosis-in-a-non-obese-patient-with-no-history-of-steroid-use/