Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(01): 217-220
DOI: 10.4103/ajns.AJNS_294_20
Case Report

Resolution of idiopathic epidural lipomatosis after bariatric surgery: Case report and literature review

Mohammad Alsofyani
Department of Surgery, College of Medicine and University Hospital, University of Hail, Hail
,
Sultan Alsalmi
1   Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, Dammam
,
Haifaa Malaekah
2   Department of Surgical, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdurrahman University, Riyadh
,
Majed Alharthi
3   Department of Surgical, Security Forces Hospital, Makkah
,
Anouar Bourghli
4   Department of Orthopedic and Spinal Surgery, Kingdom Hospital, Riyadh
,
Ibrahim Obeid
5   Department of Spine Surgery, Specialist Terrefort Clinic, Bruges
,
Louis Boissière
5   Department of Spine Surgery, Specialist Terrefort Clinic, Bruges
› Author Affiliations
› Further Information
   Permissions and Reprints

Spinal epidural lipomatosis (SEL) is traditionally a rare disorder defined as an abnormal accumulation of unencapsulated epidural fat. SEL can be classified into idiopathic and secondary. We report a 46-year-old obese male with idiopathic epidural lipomatosis with a clinical picture of bilateral L5 and S1 radiculopathy, with an L5 and S1 distribution. Magnetic resonance imaging (MRI) showed epidural lipomatosis at L4, L5, and S1. After 2-year of sleeve gastrectomy, his bilateral sciatic radiculopathy disappeared, and updated MRI showed complete resolution of epidural lipomatosis. We present a case of an unusual epidural lipomatosis, resolved completely by bariatric surgery. This case report set out the effect of metabolic surgery on the local and systemic metabolic process.

Key-words:

Bariatric - epidural lipomatosis - obesity - weight loss

Financial support and sponsorship

Nil.




Publication History

Received: 14 June 2020

Accepted: 17 December 2020

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 George WE Jr., Wilmot M, Greenhouse A, Hammeke M. Medical management of steroid-induced epidural lipomatosis. N Engl J Med 1983;308:316-9.
  • 2 McCullen GM, Spurling GR, Webster JS. Epidural lipomatosis complicating lumbar steroid injections. J Spinal Disord 1999;12:526-9.
  • 3 Fessler RG, Johnson DL, Brown FD, Erickson RK, Reid SA, Kranzler L. Epidural lipomatosis in steroid-treated patients. Spine (Phila Pa 1976) 1992;17:183-8.
  • 4 Noël P, Pepersack T, Vanbinst A, Allé JL. Spinal epidural lipomatosis in Cushing's syndrome secondary to an adrenal tumor. Neurology 1992;42:1250-1.
  • 5 Al-Khawaja D, Seex K, Eslick GD. Spinal epidural lipomatosis – A brief review. J Clin Neurosci 2008;15:1323-6.
  • 6 Błachnio-Zabielska A, Grycel S, Chacińska M, Zabielski P. The role of adipose tissue and excess of fatty acids in the induction of insulin resistance in skeletal muscle. Postepy Hig Med Dosw (Online) 2016;70:1142-9.
  • 7 Fujisawa H, Hasegawa M, Tachibana O, Yamashita J. Spinal epidural lipomatosis associated with pituitary macroprolactinoma. Acta Neurochir (Wien) 2002;144:213-4.
  • 8 Cersósimo MG, Lasala B, Folgar S, Micheli F. Epidural lipomatosis secondary to indinavir in an HIV-positive patient. Clin Neuropharmacol 2002;25:51-4.
  • 9 Vince GH, Brucker C, Langmann P, Herbold C, Solymosi L, Roosen K. Epidural spinal lipomatosis with acute onset of paraplegia in an HIV-positive patient treated with corticosteroids and protease inhibitor: Case report. Spine (Phila Pa 1976) 2005;30:E524-7.
  • 10 Badami JP, Hinck VC. Symptomatic deposition of epidural fat in a morbidly obese woman. AJNR Am J Neuroradiol 1982;3:664-5.
  • 11 Haddad SF, Hitchon PW, Godersky JC. Idiopathic and glucocorticoid-induced spinal epidural lipomatosis. J Neurosurg 1991;74:38-42.
  • 12 Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg 2006;93:738-44.
  • 13 Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: A case series of 40 consecutive patients. Obes Surg 2000;10:514-23.
  • 14 Heffron SP, Parikh A, Volodarskiy A, Ren-Fielding C, Schwartzbard A, Nicholson J, et al. Changes in lipid profile of obese patients following contemporary bariatric surgery: A meta-analysis. Am J Med 2016;129:952-9.
  • 15 Yildirim B, Puvanesarajah V, An HS, Novicoff WM, Jain A, Shen FH, et al. Lumbosacral epidural lipomatosis: A retrospective matched case-control database study. World Neurosurg 2016;96:209-14.
  • 16 Borré DG, Borré GE, Aude F, Palmieri GN. Lumbosacral epidural lipomatosis: MRI grading. Eur Radiol 2003;13:1709-21.
  • 17 van Rooij WJ, Borstlap AC, Canta LR, Tijssen CC. Lumbar epidural lipomatosis causing neurogenic claudication in two obese patients. Clin Neurol Neurosurg 1994;96:181-4.
  • 18 Beges C, Rousselin B, Chevrot A, Godefroy D, Vallee C, Berenbaum F, et al. Epidural lipomatosis. Interest of magnetic resonance imaging in a weight-reduction treated case. Spine (Phila Pa 1976) 1994;19:251-4.
  • 19 Pouchot J, Si-Hassen C, Damade R, Bayeux MC, Mathieu A, Vinceneux P. Cauda equina compression by epidural lipomatosis in obesity. Effectiveness of weight reduction. J Rheumatol 1995;22:1771-5.
  • 20 Borstlap AC, van Rooij WJ, Sluzewski M, Leyten AC, Beute G. Reversibility of lumbar epidural lipomatosis in obese patients after weight-reduction diet. Neuroradiology 1995;37:670-3.
  • 21 Qasho R, Ramundo OE, Maraglino C, Lunardi P, Ricci G. Epidural lipomatosis with lumbar radiculopathy in one obese patient. Case report and review of the literature. Neurosurg Rev 1997;20:206-9.
  • 22 Maillot F, Mulleman D, Mammou S, Goupille P, Valat JP. Is epidural lipomatosis associated with abnormality of body fat distribution? A case report. Eur Spine J 2006;15:105-8.
  • 23 Patel AJ, Sellin J, Ehni BL, Tatsui CE. Spontaneous resolution of spinal epidural lipomatosis. J Clin Neurosci 2013;20:1595-7.
  • 24 Alsofyani MA, Haignere V, Alsalmi S, Gille O, Vital JM, Pointillart V, et al. Idiopathic epidural lipomatosis associated with degenerative discopathy: Grand round presentation of unusual lumbar canal stenosis resolved by weight loss. Asian J Neurosurg 2020;15:180-3.
  • 25 Beckworth WJ, McCarty EJ, Garcia-Corrada JE, Holbrook JF. Epidural lipomatosis and associated spinal stenosis-the impact of weight loss: A case report. Am J Lifestyle Med 2017;11:511-4.
  • 26 Payer M, Van Schaeybroeck P, Reverdin A, May D. Idiopathic symptomatic epidural lipomatosis of the lumbar spine. Acta Neurochir (Wien) 2003;145:315-20.
  • 27 Ferlic PW, Mannion AF, Jeszenszky D, Porchet F, Fekete TF, Kleinstück F, et al. Patient-reported outcome of surgical treatment for lumbar spinal epidural lipomatosis. Spine J 2016;16:1333-41.
  • 28 Valcarenghi J, Bath O, Boghal H, Ruelle M, Lambert J. Benefits of bariatric surgery on spinal epidural lipomatosis: Case report and literature review. Eur J Orthop Surg Traumatol 2018;28:1437-40.
  • 29 Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and endocrine consequences of bariatric surgery. Front Endocrinol (Lausanne) 2019;10:626.