Solitary epidural lipoma with ipsilateral facet arthritis causing lumbar radiculopathy

Spinal Epidural Lipoma on the Ventral Dura Side and Intervertebral Foramen Causing Lumbar Radiculopathy

A 56-year-old obese man with a body mass index of 30.9 kg/m² presented with left sciatica and intermittent claudication. Computed tomography scans showed a posterior vertebral scalloping change in L3, L4, and L5. Meanwhile, magnetic resonance imaging revealed epidural mass posterior to the L3, L4, and L5 vertebral bodies. The solitary mass was isosignal to subcutaneous fat and asymmetrically compressed to the left side of the dural sac and L4 nerve root, as observed on axial T1- and T2-weighted images. To the best of our knowledge, there have been few reports of a solitary epidural lipoma causing lumbar radiculopathy. The patient underwent transforaminal lumbar interbody fusion at L4-L5, and his symptoms then resolved. Thus, we recommend decompression and fixation as appropriate management for lumbar radiculopathy caused by epidural lipoma located on the ventral side of the dura and intervertebral foramen.

Thoracic spine fracture associated with an extradural lipoma: Case report and systematic review of the literature

Isolated extradural lipoma (IEL), not associated to spinal dysraphisms, is a rare condition. Frequently IEL was confused with much more frequent diffuse lipomatosis. The lesion can be completely asymptomatic and occasionally diagnosed with magnetic resonance (MR) imaging. This paper describes a case of a patient with an axial compression fracture of the thoracic spine associated with an extradural lipoma. We also performed a systematic review of the pertinent literature in order to retrieve the key information regarding: the diagnosis, the clinical features and the treatment.

An intraspinal extradural lipoma with spinal epidural lipomatosis: A case report and a review of literature

Background:

Intraspinal extradural lipomas are very rare and should be differentiated from spinal epidural lipomatosis (SEL) and/or angiolipomas.

Case Description:

A 76-year-old male presented with left lower extremity radiculopathy. The magnetic resonance imaging (MRI) revealed hyperplasia of epidural fat at the L2–3 and L3–4 levels accompanied by a lipomatous L4–5 mass. Following resection of this mass and hyperplastic epidural fat, the histological examination was consistent with an intraspinal extradural lipoma and SEL.

Conclusion:

This case indicates that asymmetrical compression of the dural sac may be attributed to an intraspinal extradural lipoma vs. just SEL and/or an angiolipoma.

Epidural lipomatosis with cauda equina syndrome in chronic alcoholic patient: A case report

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Case of epidural lipomatosis with cauda equina syndrome in chronic alcoholic patient is provided.

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Posterior decompression was applied and neurologic deficit was significantly recovered.

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MRI is the best imaging tool of choice. Short T1 inversion recovery (STIR) sequence may be useful for confirmation of diagnosis as lipid is hypointense in this sequence.

Introduction

Epidural lipomatosis of the lumbar spine is a rare condition, which is described as the accumulation of fat in the extradural territory.

Presentation of case

We report the case of a 60-year-old, non-obese, and chronic alcoholic man who was transferred to our spine department with cauda equina syndrome (CES) for 4 months. On magnetic resonance imaging (MRI), spinal epidural lipomatosis (SEL) was confirmed in the multilevel lumbar lesion. A decompression surgery was performed and the patient recovered significantly.

Discussion

The patient was not obese, had no abnormal liver laboratory test results, and no history of steroid injection or administration. The clinical signs at onset suggested bilateral lower cauda equina dysfunction, indicating a more diffuse involvement, consistent with lumbosacral epidural lipomatosis.

Conclusion

This case report is the first description of SEL in a non-obese, chronic alcoholic patient who was neither receiving steroids nor had any kind of endocrinopathy.

A new pattern of lipomatosis of nerve: case report

Lipomatosis of nerve (LN) is a rare disorder of peripheral nerves that produces proliferation of interfascicular adipose tissue. It may be associated with soft-tissue and bony overgrowth within the affected nerve territory. LN has been almost exclusively reported in appendicular peripheral nerves; the median nerve at the wrist and palm is among the most common locations. The authors present a new pattern of LN that shows circumferential proliferation of fat around the epineurium of the nerve. They believe that this case and the two other documented examples in the literature (also affecting cervical and thoracic spinal nerves) share the same new pattern of LN. Defining the full spectrum of adipose lesions of the nerve and establishing a cause-effect relationship with nerve-territory overgrowth disorders may offer options for future management through targeted nerve lesioning.

Radiculopathy in the setting of lumbar nerve root compression due to an extradural intraforaminal lipoma: a report of 3 cases

A true adult spinal lipoma is an exceedingly rare cause of lumbar compression neuropathy. Only 5 cases of true extradural intraforaminal lipomas have been documented in the medical literature. The diagnostic criteria and treatment guidelines for this specific lipoma have yet to be established. This report features 3 histologically confirmed cases of extradural intraforaminal spinal lipomas that recently presented to the authors’ practice. In addition, the literature was surveyed to include the 5 previously reported cases of true adult extradural intraforaminal spinal lipomas. The consistency in presentation, response to surgical intervention, and postoperative recovery in these 8 cases supports surgical intervention at the time of diagnosis. The authors’ findings support elevated clinical suspicion, efficient diagnosis based on MRI, and early surgical intervention for this rare pathological entity. All cases presented in this report were symptomatic and occurred in the absence of other significant pathologies such as general spinal epidural lipomatosis, intradural lesions, tethering, or severe degenerative stenosis or herniated discs. The clinical, neuroradiological, and histological findings characteristic of a true adult extradural intraforaminal lipoma are emphasized to differentiate this lesion from the more common etiologies for lumbar compression neuropathy. Heightened awareness and clinical suspicion for the focal, foraminal spinal lipoma as a cause of radiculopathy symptoms will enable more efficient diagnosis and treatment.