Spinal epidural lipomatosis: presentation of two idiopathic cases and review of the literature

Spinal epidural lipomatosis (SEL) is a rare cause of low back pain and radiculopathy and is usually associated with exogenous steroid therapy and endocrinopathy. The idiopathic form is even more rare and presented mainly in obese patients. SEL appears in the lumbar and thoracic spine and has never been reported in the cervical spine. The deposition of adipose tissue in the spinal canal produces slowly progressing symptoms (low back pain and intermittent claudication) due to compression of the spinal cord and roots. Surgical therapy provides immediate relief, but has a reported mortality rate of over 20%, due to the co-morbidity of these patients. We present two cases of lumbar radiculopathy due to idiopathic spinal epidural lipomatosis. One patient was treated surgically (removal of excessive epidural adipose tissue combined with decompressive laminectomy and foraminotomy), while the other was placed under a low-calorie diet and both improved neurologically.