Spinal Epidural Lipomatosis: A Review of Its Causes and Recommendations for Treatment

Daniel R. Fassett, MD, MBA; Meic H. Schmidt, MD


Neurosurg Focus. 2004;16(4) 

In This Article

Abstract and Introduction

Spinal epidural lipomatosis is most commonly observed in patients receiving long-term exogenous steroid therapy, but can also be seen in patients with endogenous steroid overproduction, obesity, or idiopathic disease. With this condition, there is hypertrophy of the epidural adipose tissue, causing a narrowing of the spinal canal and compression of neural structures. A majority of patients will present with progressive myelopathy, but radicular symptoms are also common. Conservative treatment—weaning from steroids or weight loss—can reverse the hypertrophy of the adipose tissue and relieve the neural compression. If conservative management fails, surgery with decompressive laminectomy is also very successful at improving the patient's neurological symptoms.

Spinal epidural lipomatosis is a rare and complex disorder that can present with progressive neurological deficits. Hypertrophy of adipose tissue located in the spinal epidural space is most commonly associated with long-term steroid use but can be observed in patients with a number of other conditions. As the adipose tissue enlarges, it encroaches on the spinal canal and compresses the neural elements. We have reviewed the literature on SEL and summarize current trends in the management of this condition.