Spinal Epidural Lipomatosis: a Case Report and Review of the Literature

Spinal Stenosis Clinical Trial

Official title:

Spinal Epidural Lipomatosis: a Case Report and Review of the Literature

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04622501
• Other study ID #: 202015
• Status: Completed
• Start date: June 10, 2019
• Est. completion date: June 10, 2020

Study information

• Verified date: November 2020
• Source: Canadian Memorial Chiropractic College
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

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 current literature.

Case presentation A 51-year-old female presented at a spine clinic with low back pain, bilateral leg pain and difficulty walking. MR imaging of the lumbar spine showed L4-L5 and L5-S1 degenerative disk disease with evidence of severe central canal stenosis due to extensive epidural lipomatosis. The patient was initially advised to lose weight, undergo a course of physiotherapy, and consult with the pain clinic. Because of lack of improvement, the patient was scheduled for L4-S1 posterior spinal decompression and L4-L5 posterior spinal instrumented fusion.

Discussion The discussion will include the diagnosis of SEL, imaging appearance, its risk factors, etiology and management.

Conclusion This case report describes a case of lumbar spinal stenosis due to SEL with neurological symptoms. Some risk factors have also been identified in the literature. MRI is considered as the reference standard for its diagnosis. The therapeutic approach of patients with SEL is not standardized. Thus, reporting and investigating the diagnostic process and treatment of this patient will positively contribute to better management for other future patients.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1
• Est. completion date: June 10, 2020
• Est. primary completion date: June 11, 2019
• Gender: All
• Age group: 18 Years to 100 Years

Eligibility

Inclusion Criteria:

• Adults patient with a clinical diagnosis of Spinal Epidural Lipomatosis (MRI and clinical diagnosis)

Exclusion Criteria:

• Absence of clinical diagnosis of Spinal Epidural Lipomatosis

Related Conditions & MeSH terms

• Spinal Stenosis

Intervention

Procedure:
• posterior spinal decompression and posterior spinal instrumented fusion
posterior spinal decompression and posterior spinal instrumented fusion performed on a patient with Spinal Epidural Lipomatosis

Locations

Country	Name	City	State
Canada	CMCC	Toronto	Ontario

Sponsors (1)

Lead Sponsor	Collaborator
Canadian Memorial Chiropractic College

Country where clinical trial is conducted

Canada, 

References & Publications (10)

Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler AJ, Orgill DP; SCARE Group. The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 2018 Dec;60:132-136. doi: 10.1016/j.ijsu.2018.10.028. Epub 2018 Oct 18. — View Citation

Borré DG, Borré GE, Aude F, Palmieri GN. Lumbosacral epidural lipomatosis: MRI grading. Eur Radiol. 2003 Jul;13(7):1709-21. Epub 2002 Dec 13. — View Citation

Fassett DR, Schmidt MH. Spinal epidural lipomatosis: a review of its causes and recommendations for treatment. Neurosurg Focus. 2004 Apr 15;16(4):E11. Review. — View Citation

Ferlic PW, Mannion AF, Jeszenszky D, Porchet F, Fekete TF, Kleinstück F, Haschtmann D. Patient-reported outcome of surgical treatment for lumbar spinal epidural lipomatosis. Spine J. 2016 Nov;16(11):1333-1341. doi: 10.1016/j.spinee.2016.06.022. Epub 2016 Jun 27. — View Citation

Fogel GR, Cunningham PY 3rd, Esses SI. Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J. 2005 Mar-Apr;5(2):202-11. — View Citation

Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine J. 2019 Sep;9(6):658-665. doi: 10.1177/2192568218793617. Epub 2018 Aug 13. Review. — View Citation

Malone JB, Bevan PJ, Lewis TJ, Nelson AD, Blaty DE, Kahan ME. Incidence of spinal epidural lipomatosis in patients with spinal stenosis. J Orthop. 2017 Nov 6;15(1):36-39. doi: 10.1016/j.jor.2017.11.001. eCollection 2018 Mar. — View Citation

Theyskens NC, Paulino Pereira NR, Janssen SJ, Bono CM, Schwab JH, Cha TD. The prevalence of spinal epidural lipomatosis on magnetic resonance imaging. Spine J. 2017 Jul;17(7):969-976. doi: 10.1016/j.spinee.2017.02.010. Epub 2017 Mar 3. — View Citation

Wälchli B, Benini A. Spinal epidural lipomatosis. Swiss Med Wkly. 2001 Jun 16;131(23-24):359. — View Citation

Yildirim B, Puvanesarajah V, An HS, Novicoff WM, Jain A, Shen FH, Hassanzadeh H. Lumbosacral Epidural Lipomatosis: A Retrospective Matched Case-Control Database Study. World Neurosurg. 2016 Dec;96:209-214. doi: 10.1016/j.wneu.2016.08.125. Epub 2016 Sep 5. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Low back pain	Visual Pain Scale (0-10)	3 months before surgery
Primary	Low back pain	Visual Pain Scale (0-10)	6 weeks after surgery
Primary	Distance Walking	Distance walking (meter)	3 months before surgery
Primary	Distance Walking	Distance walking (meter)	6 weeks after surgery
Primary	Low back pain	Visual Pain Scale (0-10)	3 months after surgery
Primary	Low back pain	Visual Pain Scale (0-10)	1 year after surgery
Primary	Distance walking	Distance walking (meter)	3 months after surgery
Primary	Distance walking	Distance walking (meter)	1 year after surgery