Fabrice Mallard1, Manar Buni2, Paul S Nolet3, Peter Emary4, John A Taylor5, Gemah Moammer6. 1. Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Institut Franco-Européen de Chiropraxie, Toulouse, France. Electronic address: fmallard@cmcc.ca. 2. Faculty of Medicine, University of Szeged, Szeged, Hungary. 3. Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands. 4. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Private Practice, Cambridge, Ontario, Canada; D'Youville College, Department of Chiropractic, Buffalo, New York, USA. 5. D'Youville College, Department of Chiropractic, Buffalo, New York, USA. 6. McMaster University, Grand River Hospital, Kitchener, Ontario, Canada; Spine Surgery, Grand River Hospital Corporation, Kitchener Waterloo Site, Ontario, Canada; Spine Surgery, St Mary's General Hospital, Kitchener, Ontario, Canada. Electronic address: gmoammer@yahoo.com.
Abstract
INTRODUCTION: Lumbar spinal epidural lipomatosis (SEL) is a rare condition defined by an excessive deposition of adipose tissue in the lumbar spinal canal. The objective of this case report is to document a clinical case of SEL presenting within a multidisciplinary spine clinic and to compare our clinical findings and management with the available literature. CASE PRESENTATION: A 51-year-old female presented at a spine clinic with low back pain, bilateral leg pain and difficulty walking. Magnetic resonance imaging of the lumbar spine showed evidence of severe central canal stenosis due to extensive epidural lipomatosis. She was initially advised to lose weight and undergo a 3-month course of physiotherapy. However, because of lack of improvement, she was scheduled for and underwent L4-S1 posterior spinal decompression and L4-L5 posterior spinal instrumented fusion. At 12-month follow-up, the patient reported no pain and retained the ability to walk regular distances without experiencing discomfort. DISCUSSION: This case report describes the conservative and surgical management of a case of lumbar spinal stenosis due to SEL. The therapeutic approach of patients with this condition is not standardized. As such, a discussion of the literature with respect to the diagnosis, clinical presentation, epidemiology, imaging appearance, risk factors, etiology, and management of SEL is also presented.
INTRODUCTION: Lumbar spinal epidural lipomatosis (SEL) is a rare condition defined by an excessive deposition of adipose tissue in the lumbar spinal canal. The objective of this case report is to document a clinical case of SEL presenting within a multidisciplinary spine clinic and to compare our clinical findings and management with the available literature. CASE PRESENTATION: A 51-year-old female presented at a spine clinic with low back pain, bilateral leg pain and difficulty walking. Magnetic resonance imaging of the lumbar spine showed evidence of severe central canal stenosis due to extensive epidural lipomatosis. She was initially advised to lose weight and undergo a 3-month course of physiotherapy. However, because of lack of improvement, she was scheduled for and underwent L4-S1 posterior spinal decompression and L4-L5 posterior spinal instrumented fusion. At 12-month follow-up, the patient reported no pain and retained the ability to walk regular distances without experiencing discomfort. DISCUSSION: This case report describes the conservative and surgical management of a case of lumbar spinal stenosis due to SEL. The therapeutic approach of patients with this condition is not standardized. As such, a discussion of the literature with respect to the diagnosis, clinical presentation, epidemiology, imaging appearance, risk factors, etiology, and management of SEL is also presented.