Idiopathic Thoracic Spinal Epidural Lipomatosis With Relapsing And Remitting Symptoms

Abstract

Background context: Spinal epidural lipomatosis (SEL) is a disease consisting of an excessive deposition of normal adipose tissue in the spinal canal. It is a quite uncommon disease, which can end to severe neurological deterioration. Method: This report presents a patient with idiopathic SEL with relapsing and remitting course. After a 16-month period with clinical improvement, following conservative treatment, the patient was presented with rapid neurological deterioration, consisting in spastic paraparesis. Such a fluctuating presentation is rare in patients with SEL, and mimics a demyelinization disease. Multilevel laminectomy from Th6 to Th10, and resection of thick non-capsulated fatty tissue, was performed. Results: Postoperatively the patient regained gradually lower extremity power. Fifteen days postoperatively he developed an epidural haematoma, due to treatment with high doses of anticoagulants for unstable angina. He presented with rapid neurologic deterioration and operated on for haematoma evacuation. The symptoms resolved the next 24 hours and on follow-up six months later he was able to walk and climb stairs without assistance.Conclusions: These patients have high operative risks due to accompanied medical problems. We suggest conservative treatment for patients with minor symptoms, reserving surgical decompression for cases with progressive neurological deterioration.