An unusual complication of morbid obesity: epidural lipomatosis

Epidural lipomatosis is a rare disease to cause spinal cord compression and progressive neurologic deficits. Hypertrophy of adipose tissue located in the spinal epidural space encroaches on the spinal canal and compresses the neural elements. Most patients will present with worsening myelopathy, but radicular symptoms may also be seen. It is found most commonly in patients with excess of steroids in the body either due to endogenous source or exogenous intake. However, we report a rare case in which a young, morbidly obese patient admits to relapsing and remitting paraparesis and incontinence-which later is found to be caused by epidural lipomatosis evidenced via magnetic resonance imaging of the spine. Treatment depends upon neurologic status of the patient. As our patient's chief complaints resolved with improved associated symptoms, she received conservative treatment-strict education about weight loss/management, recommendations to a weight loss program, and a referral to a pediatric endocrinologist for more in-depth study. For those whom it may apply, conservative treatment also includes weaning from steroids, which 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 neurologic symptoms.