Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature

2006 ◽  
Vol 4 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Yoshinori Ishikawa ◽  
Yoichi Shimada ◽  
Naohisa Miyakoshi ◽  
Tetsuya Suzuki ◽  
Michio Hongo ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Symptoms ◽  
Symptomatic Relief ◽  
Japanese Orthopaedic Association ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Epidural Lipomatosis ◽  
Epidural Fat ◽  
Spinal Epidural

Object Idiopathic symptomatic spinal epidural lipomatosis (SEL) is a rare condition, and few reports have discussed diagnostic imaging criteria. To evaluate factors relating to its clinical symptoms, correlations between clinical features and the presence of spinal epidural fat were investigated, and the literature concerning idiopathic SEL was reviewed. Methods Morphological gradings of epidural fat were evaluated in seven patients with idiopathic SEL by using magnetic resonance (MR) imaging. In addition, body mass index (BMI), the number of involved vertebral levels, grade, and preoperative Japanese Orthopaedic Association (JOA) score were analyzed. Surgery resulted in symptomatic relief, with a mean JOA score recovery rate of 67.4%. Grading of epidural fat tended to display a slight negative correlation with preoperative JOA score, whereas a strong significant positive correlation was found between the number of involved vertebral levels and BMI. Conclusions The number of involved vertebral levels and obesity are strongly correlated, whereas severity of dural compression is not always significantly associated with neurological complications. These results indicate that epidural fat of the lumbar spine contributes to neurological deficits. In addition, weight-reduction therapy appears to decrease the number of vertebral levels involved. Magnetic resonance imaging–based grading is helpful for the diagnosis and evaluation of idiopathic lumbar SEL. Moreover, symptoms and neurological findings are important for determining the surgical approach.

Epidural Lipomatosis

2007 ◽  
Vol 7 (4) ◽  
pp. 463-464
Author(s):  
Daniel G. Borré
Keyword(s):  
Magnetic Resonance ◽  
Clinical Symptoms ◽  
Symptomatic Relief ◽  
Japanese Orthopaedic Association ◽  
Rare Condition ◽  
Neurological Complications ◽  
Neurological Deficits ◽  
Epidural Lipomatosis ◽  
Epidural Fat ◽  
Spinal Epidural

Object Idiopathic symptomatic spinal epidural lipomatosis (SEL) is a rare condition, and few reports have discussed diagnostic imaging criteria. To evaluate factors relating to its clinical symptoms, correlations between clinical features and the presence of spinal epidural fat were investigated, and the literature concerning idiopathic SEL was reviewed. Methods Morphological gradings of epidural fat were evaluated in seven patients with idiopathic SEL by using magnetic resonance (MR) imaging. In addition, body mass index (BMI), the number of involved vertebral levels, grade, and preoperative Japanese Orthopaedic Association (JOA) score were analyzed. Surgery resulted in symptomatic relief, with a mean JOA score recovery rate of 67.4%. Grading of epidural fat tended to display a slight negative correlation with preoperative JOA score, whereas a strong significant positive correlation was found between the number of involved vertebral levels and BMI. Conclusions The number of involved vertebral levels and obesity are strongly correlated, whereas severity of dural compression is not always significantly associated with neurological complications. These results indicate that epidural fat of the lumbar spine contributes to neurological deficits. In addition, weight-reduction therapy appears to decrease the number of vertebral levels involved. Magnetic resonance imaging–based grading is helpful for the diagnosis and evaluation of idiopathic lumbar SEL. Moreover, symptoms and neurological findings are important for determining the surgical approach.

Spinal Epidural Lipomatosis in Lumbar Magnetic Resonance Imaging Scans

Orthopedics ◽  
2014 ◽  
Vol 37 (4) ◽  
pp. e362-e366 ◽  
Author(s):  
Hisashi Sugaya ◽  
Toshikazu Tanaka ◽  
Takeshi Ogawa ◽  
Hajime Mishima
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Spinal Epidural Lipomatosis ◽  
Epidural Lipomatosis ◽  
Spinal Epidural

scholarly journals Spinal Epidural Lipomatosis Associated with Intrathecal Flow Voids: Demonstration of Engorged Veins Using Flat Panel Catheter Angiotomography

2021 ◽  
Author(s):  
Nishtha Yadav ◽  
Ketan Hedaoo ◽  
Ambuj Kumar
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Venous Plexus ◽  
Flat Panel ◽  
Spinal Epidural Lipomatosis ◽  
Epidural Lipomatosis ◽  
Spinal Epidural ◽  
Venous Disorders

AbstractWe present a case of a 54-year-old male with spinal epidural lipomatosis who had associated flow voids on magnetic resonance imaging with dilated intrathecal vessels. During spinal angiogram, 20s DynaCT (flat panel catheter angiotomography) was utilized to demonstrate the intrathecal engorged veins. Venous engorgement of epidural venous plexus has been previously described in epidural lipomatosis; however, dilated intrathecal perimedullary veins have not been demonstrated by imaging. We have described the utility of flat panel catheter angiotomography in understanding venous disorders in such patients.

Magnetic resonance imaging for low back pain: indications and limitations

2009 ◽  
Vol 69 (01) ◽  
pp. 7-11 ◽  
Author(s):  
N J Sheehan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Low Back Pain ◽  
Back Pain ◽  
Magnetic Resonance ◽  
Clinical Symptoms ◽  
Neurological Deficits ◽  
Spinal Diseases ◽  
Low Back ◽  
Resonance Imaging ◽  
National Guidelines

Magnetic resonance imaging (MRI) is the preferred investigation for most spinal diseases and is increasingly requested for people with low back pain (LBP). However, determining the cause of back pain is complicated as it is often multifactorial and anatomical abnormalities are common in the spine and may not necessarily translate into clinical symptoms. Thus, national guidelines discourage the use of MRI in non-specific LBP and recommend reserving it for the investigation of severe or progressive neurological deficits or for those cases in which serious underlying pathology is suspected. It also has an acknowledged role in planning surgical management in cases of radiculopathy and spinal stenosis. This review summarises the indications for MRI in LBP and calls for improved education of patients and health professionals in the limitations of this investigation.

The prevalence of spinal epidural lipomatosis on magnetic resonance imaging

2017 ◽  
Vol 17 (7) ◽  
pp. 969-976 ◽  
Author(s):  
Nina C. Theyskens ◽  
Nuno Rui Paulino Pereira ◽  
Stein J. Janssen ◽  
Christopher M. Bono ◽  
Joseph H. Schwab ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Spinal Epidural Lipomatosis ◽  
Epidural Lipomatosis ◽  
Spinal Epidural

The Value of Magnetic Resonance Imaging in the Evaluation of Fatty Filum Terminale

Neurosurgery ◽  
2004 ◽  
Vol 54 (2) ◽  
pp. 375-380 ◽  
Author(s):  
Ketan R. Bulsara ◽  
Ali R. Zomorodi ◽  
David S. Enterline ◽  
Timothy M. George
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Clinical Symptoms ◽  
Conus Medullaris ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Group Iii ◽  
Group I ◽  
Significant Difference ◽  
Mri Scans

Abstract OBJECTIVE To determine whether there are magnetic resonance imaging (MRI) characteristics of fatty fila that are correlated with neurological deficits, especially in the presence of a normal-level conus medullaris. METHODS Lumbosacral MRI scans were reviewed for patients with fatty fila who were treated at Duke University Medical Center during a 5-year period. The patients were divided into three groups. Group I patients (n = 5) had fatty fila that were incidentally detected during evaluations for metastases or infections. Group II patients (n = 16) exhibited isolated low back pain but were in neurologically intact condition. Group III patients (n = 15) exhibited neurological impairments consistent with distal spinal cord dysfunction. Several characteristics were measured on the MRI scans, including the location of the conus medullaris, the filum thickness, and the distance of fat from the conus. These results were assessed for statistically significant correlation with the presence of clinical symptoms. RESULTS The majority of patients in all three groups demonstrated the normal conus position (L2 or above) and thickened fila. The distance of fat from the conus was the only parameter that demonstrated a statistically significant difference among the groups. CONCLUSION The following findings were noted: 1) patients were likely to exhibit neurological deficits at a younger age (<22 yr in Group III versus 47 yr in Groups I and II); 2) a conus level below L2 was associated with neurological deficits (Group III); 3) filum thickness was not correlated with clinical presentation; 4) fat in the filum within 13 mm of the conus medullaris was most predictive of neurological deficits (Group III).

Radiographic Prevalence and Predisposing Factors Associated with Finding Spinal Epidural Lipomatosis on Magnetic Resonance Imaging

2016 ◽  
Vol 16 (10) ◽  
pp. S198-S199
Author(s):  
Nuno Rui Paulino Pereira ◽  
Nina Theyskens ◽  
Stein Janssen ◽  
Bianca Verbeek ◽  
Joseph H. Schwab ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Predisposing Factors ◽  
Resonance Imaging ◽  
Spinal Epidural Lipomatosis ◽  
Epidural Lipomatosis ◽  
Factors Associated ◽  
Spinal Epidural

Magnetic Resonance Imaging Findings and Clinical Outcomes in the Early Postoperative Period after Full Endoscopic Diskectomy for Lumbar Disk Herniation

2021 ◽  
Author(s):  
Tomoya Terai ◽  
Takashi Chikawa ◽  
Tatsuhiko Henmi ◽  
Koichi Sairyo
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Postoperative Period ◽  
Clinical Symptoms ◽  
Early Stage ◽  
Japanese Orthopaedic Association ◽  
Early Postoperative Period ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Postoperative Mri

Abstract Introduction This prospective case-control study aimed to establish the normal spectrum of early magnetic resonance imaging (MRI) findings in patients whose symptoms resolve after full endoscopic diskectomy (FED). We examined the changes in postoperative MRI findings and their relation to early clinical symptoms. Methods In total, 33 patients underwent FED under local anesthesia. Clinical assessments and MRI examinations were performed preoperatively and immediately (within 1 week) and late (at 3 and 12 months) postoperatively. Residual disk bulging after surgery was classified into four grades compared with preoperative MRI findings: none (grade A), <25% (grade B), 25–75% (grade C), and >75% (grade D). Results MRI at postoperative week 1 showed grade B residual disk bulging in 9 patients, grade C residual disk bulging in 8 patients, and grade D residual disk bulging in 16 patients. Improvement was seen at postoperative month 3 (grade A in 18 patients, grade B in 10 patients, and grade C in 5 patients) and at postoperative month 12 (grade A in 29 patients, grade B in 3 patients, and grade C in 1 patient). Visual analog scale scores and the Japanese Orthopaedic Association scores showed significant differences at 1 week, 3 months, and 12 months after surgery. Conclusion Postoperative MRI findings within 1 week of FED showed grade C or D residual disk material in 24 of 33 patients (73%). Clinical symptoms improved in the early postoperative period, even though residual disk bulging was present. Persisting residual bulging in the early stage following surgery may not correlate with clinical symptoms.

Use of Omnipaque Intraoperative Dye in the Surgical Treatment of Pan-Spinal Epidural Abscesses: Technical Case Report

2015 ◽  
Vol 11 (3) ◽  
pp. E479-E482
Author(s):  
Nicolas K Khattar ◽  
Benjamin M Zussman ◽  
Nitin Agarwal ◽  
Hope K George ◽  
Adnan A Abla
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Epidural Space ◽  
Neurological Deficits ◽  
High Morbidity ◽  
Open Approach ◽  
Resonance Imaging ◽  
Surgical Interventions ◽  
Lower Back ◽  
Spinal Epidural

Abstract BACKGROUND AND IMPORTANCE Spinal epidural abscesses are difficult to diagnose and could have high morbidity and mortality if left untreated. If patients present with acute neurological deficits and evidence of a multilevel ventral spine abscess on neuroimaging, blood cultures should be taken and the abscess emergently evacuated in patients able to tolerate surgical interventions. CLINICAL PRESENTATION A 57-year-old man presented with lower back pain, which progressed to include urinary retention and evidence of lumbar discitis/osteomyelitis on magnetic resonance imaging. The patient was started on antibiotic therapy. After the patient developed new cervical pain, interval magnetic resonance imaging showed extension of the abscess to involve the cervical, thoracic, and lumbar spine with intraventricular extension. The decision was made to perform a C4 corpectomy and insert a flexible ventriculoperitoneal catheter to serially flush out the abscess. Omnipaque dye was then used to ensure that the entire abscess was evacuated and no septations existed in the anterior epidural space. CONCLUSION The patient's neurological deficits completely resolved, and he is intact a year after the operation. In selected patients with pan-spinal epidural abscesses associated with acute neurological deficits, a combination of an open approach and a catheter-based procedure in addition to an intraoperative monitoring option to ensure complete evacuation of the abscess and absence of septations in the anterior epidural space is a low-morbidity option in the armamentarium of the surgeon.

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