2022 年 36 巻 1 号 p. 82-87
Objectives : Spinal epidural lipomatosis (SEL) is a relatively rare disease characterized by an overgrowth of epidural adipose tissue within the spinal canal. SEL can be asymptomatic, and patients often present with symptoms related to nerve or spinal cord compression.
Case Presentation : A 50-year-old man was admitted to our hospital with pain in the lumbar region and leg, in 2020. He was self-reliant in his daily life, but had a history of lumbar surgery. MRI showed compression of the spinal nerve of the cauda equina within the spinal tube due to lumbar SEL. The “lateral I” sign of thecal sac compression was seen at L2/3 and L3/4 levels.
A full endoscopic interlaminar approach for L3/4 and L4/5 was performed a month after admission. This surgery included placing the patient in the prone position, full endoscopic spinal surgery, interlaminar approach, dissection of the yellow ligament, and removal of the epidural hypertrophic adipose tissue. After post-surgical rehabilitation, the patient made a full recovery at discharge, and returned to his life.
Discussion : SEL is a relatively rare disease. To date, SEL and secondary SEL require long periods of exogenous steroid use.
Distinctive features of idiopathic SEL is the common occurrence in men, mostly in the lumbar region.
MRI showed compression of the spinal nerve of the cauda equina within the spinal tube due to lumbar SEL. The “lateral I” sign at L2/3 and L3/4 levels, and the typical “Y” sign at L4/5 and L5/S1 levels of thecal sac compression were seen.
In general, the removal of SEL produces good results, with or without microscopic surgery. We believe that full endoscopic spinal surgery for symptomatic lumbar SEL is a good choice of minimally invasive surgery. This requires the accumulation of the cases before this procedure is standardized.
Conclusions : We report our experience with symptomatic idiopathic lumbar SEL with a “lateral I” sign on axial MRI, and effective full endoscopic spinal surgery.
