Spinal epidural lipomatosis

An 87-year-old man presented with a 1-week history of progressive low back pain radiating into the posterior aspect of the right thigh. Two years previously, he had been diagnosed with microscopic polyangiitis and treated with prednisone at a 5-mg daily dose. Physical examination was notable for muscle weakness in the right lower limb and intermittent claudication, with bilaterally exaggerated patellar and Achilles tendon reflexes. Supine positioning exacerbated his back pain. A spinal magnetic resonance imaging (MRI) scan showed an overgrowth of epidural fat compressing the dural sac at L2 –L4 (Figure  1), which confirmed the diagnosis of spinal epidural lipomatosis (SEL). To prevent losing his ambulatory abilities, the patient opted for surgical intervention and underwent posterior lumbar decompression surgery, which relieved his symptoms.
Source: QJM - Category: Internal Medicine Source Type: research