Introduction: Spinal epidural lipomatosis (SEL) is a rare spinal condition characterized by abnormal deposition of un-encapsulated fat in the epidural space. It can be classified as idiopathic or secondary (ofter related to long term corticosteroid treatment), and may show an indolent course with episodes of abrupt worsening. Neurological deficits or persistent back pain represent the only indications for surgery, thus most cases are managed conservatively.
Methods: Herein we present a multicentric retrospective analysis of 14 SEL followed over a period of 5 years. Data from OutPatient Clinics (including VAS and SF12 questionnaires) and neuroradiological investigations were reviewed aiming to better define the clinical course of this pathological entity, along with its causative and prognostic factors.
Results: SEL resulted associated with excess of steroid levels in >50% of our patients, either because of exogenous steroid administration (as in Systemic Lupus Erythematosis) or endogenous excess steroid secretion (as in Cushing's disease). 79% of patient had morbid obesity (BMI 30 or higher), whereas only 3 idiopathic cases were identified. 71% of patient presented with mild to moderate back pain, whereas no cases of neurological deficits were recorded during the observational period. The VAS grade resulted directly proportional to: 1) initial BMI, 2) the prescribed corticosteroid dose and 3) overall lenght of treatment. Nonetheless those factors did not seem to be correlated with the chances of improvement or time to recovery. In fact, a conservative approach, which included weight loss, progressive corticosteroid withdrawal and analgesic management led to improvement of VAS and SF12 in all cases but one.
Conclusions: Our experience seems to suggest that the initial VAS grade is not related to the rate or degree of recovery; thus confirming that a conservative management can be considered as the mainstay of treatment in patients diagnosed with SEL, until required otherwise should evolving neurological deficits occur.
Patient Care: This multicentric study was meant to better define the clinical course of SEL and the rationale for conservative or surgical treatments. Its results will specifically help to understand which prognostic factors need to be taken into account during the follow up of those patients.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) describe the risk factors for SEL
2) understand its clinical course
3) discuss in small groups its management options