Clinical trial NCT04622501: Spinal Epidural Lipomatosis: a Case Report and Review of the Literature
Official title: Spinal Epidural Lipomatosis: a Case Report and Review of the Literature
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Spinal Stenosis
Lead sponsor: Canadian Memorial Chiropractic College
Sponsor class: OTHER
First posted: 2020-11-10
Enrollment: 1
Sex: ALL
Minimum age (years): 18
Maximum age (years): 100
Standard ages: ADULT
OLDER_ADULT
Observational model: CASE_ONLY
Time perspective: CROSS_SECTIONAL
Sampling method: PROBABILITY_SAMPLE
Study population: Patients consulting in a multidisciplinary spine clinic

Brief summary: Introduction Lumbar spinal epidural lipomatosis (SEL) is a rare condition defined by an excessive deposition of adipose tissue in the lumbar spinal canal. The objective of this case report is to document a clinical case of SEL presenting within a multidisciplinary spine clinic and to compare our clinical findings and management with the current literature.

Case presentation A 51-year-old female presented at a spine clinic with low back pain, bilateral leg pain and difficulty walking. MR imaging of the lumbar spine showed L4-L5 and L5-S1 degenerative disk disease with evidence of severe central canal stenosis due to extensive epidural lipomatosis. The patient was initially advised to lose weight, undergo a course of physiotherapy, and consult with the pain clinic. Because of lack of improvement, the patient was scheduled for L4-S1 posterior spinal decompression and L4-L5 posterior spinal instrumented fusion.

Discussion The discussion will include the diagnosis of SEL, imaging appearance, its risk factors, etiology and management.

Conclusion This case report describes a case of lumbar spinal stenosis due to SEL with neurological symptoms. Some risk factors have also been identified in the literature. MRI is considered as the reference standard for its diagnosis. The therapeutic approach of patients with SEL is not standardized. Thus, reporting and investigating the diagnostic process and treatment of this patient will positively contribute to better management for other future patients.


Eligibility criteria: Inclusion Criteria:

* Adults patient with a clinical diagnosis of Spinal Epidural Lipomatosis (MRI and clinical diagnosis)

Exclusion Criteria:

* Absence of clinical diagnosis of Spinal Epidural Lipomatosis

Primary outcomes:
measure: Low back pain
timeFrame: 3 months before surgery
measure: Low back pain
timeFrame: 6 weeks after surgery
measure: Distance Walking
timeFrame: 3 months before surgery
measure: Distance Walking
timeFrame: 6 weeks after surgery
measure: Low back pain
timeFrame: 3 months after surgery
measure: Low back pain
timeFrame: 1 year after surgery
measure: Distance walking
timeFrame: 3 months after surgery
measure: Distance walking
timeFrame: 1 year after surgery
Secondary outcomes:
Other outcomes:
Locations:
city: Toronto
country: Canada
facility: CMCC
state: Ontario
Study officials:
References:
citation: Borre DG, Borre GE, Aude F, Palmieri GN. Lumbosacral epidural lipomatosis: MRI grading. Eur Radiol. 2003 Jul;13(7):1709-21. doi: 10.1007/s00330-002-1716-4. Epub 2002 Dec 13.
citation: Fogel GR, Cunningham PY 3rd, Esses SI. Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J. 2005 Mar-Apr;5(2):202-11. doi: 10.1016/j.spinee.2004.05.252.
citation: Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler AJ, Orgill DP; SCARE Group. The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 2018 Dec;60:132-136. doi: 10.1016/j.ijsu.2018.10.028. Epub 2018 Oct 18.
citation: Fassett DR, Schmidt MH. Spinal epidural lipomatosis: a review of its causes and recommendations for treatment. Neurosurg Focus. 2004 Apr 15;16(4):E11.
citation: Theyskens NC, Paulino Pereira NR, Janssen SJ, Bono CM, Schwab JH, Cha TD. The prevalence of spinal epidural lipomatosis on magnetic resonance imaging. Spine J. 2017 Jul;17(7):969-976. doi: 10.1016/j.spinee.2017.02.010. Epub 2017 Mar 3.
citation: Yildirim B, Puvanesarajah V, An HS, Novicoff WM, Jain A, Shen FH, Hassanzadeh H. Lumbosacral Epidural Lipomatosis: A Retrospective Matched Case-Control Database Study. World Neurosurg. 2016 Dec;96:209-214. doi: 10.1016/j.wneu.2016.08.125. Epub 2016 Sep 5.
citation: Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine J. 2019 Sep;9(6):658-665. doi: 10.1177/2192568218793617. Epub 2018 Aug 13.
citation: Malone JB, Bevan PJ, Lewis TJ, Nelson AD, Blaty DE, Kahan ME. Incidence of spinal epidural lipomatosis in patients with spinal stenosis. J Orthop. 2017 Nov 6;15(1):36-39. doi: 10.1016/j.jor.2017.11.001. eCollection 2018 Mar.
citation: Walchli B, Benini A. Spinal epidural lipomatosis. Swiss Med Wkly. 2001 Jun 16;131(23-24):359. doi: 10.4414/smw.2001.09739. No abstract available.
citation: Ferlic PW, Mannion AF, Jeszenszky D, Porchet F, Fekete TF, Kleinstuck F, Haschtmann D. Patient-reported outcome of surgical treatment for lumbar spinal epidural lipomatosis. Spine J. 2016 Nov;16(11):1333-1341. doi: 10.1016/j.spinee.2016.06.022. Epub 2016 Jun 27.