Nadtwardówkowa lipomatoza kanału kręgowego – diagnostyka i leczenie

Epidural lipomatosis of the spinal canal is a rare disorder involving the overgrowth of encapsulated adipose tissue in the epidural space within the spinal canal. It is a rare cause of neurogenic claudication and increasing loss of neurological symptoms.
The location of adipose tissue in the posterior space of the canal is considered a variant of the correct anatomical structure. Only its excess, causing neurological symptoms, is considered a pathological condition [1]. The aetiology of the disease remains unknown. Factors that may participate in the development of the disease are considered to be civilisation diseases such as type 2 diabetes and thyroid dysfunction or iatrogenic factors, e.g. chronic steroid therapy.
The symptoms of this disease include all the symptoms associated with the compression of nerve structures in the spinal canal or vertebral foramen, and thus the following: pain in the lower back, symptoms that intensify when walking and upright spine positions – neurogenic claudication, sciatica, burning and numbness in the leg, in severe cases, paresis and drooping feet, or loss of sphincter control.
The main tool of the diagnostic process in spinal epidural lipomatosis (SEL) is magnetic resonance imaging (MRI). Diagnosis includes thorough medical history, medical examination, and additional tests (RTG, CT). In the medical examination, special attention should be paid to the walking distance, examine the way of moving on the heels and toes, assess pelvic stability, muscular strength of the lower limbs, knee, and Achilles tendon reflexes.
Treatment in most cases remains conservative. As a rule, this is symptomatic treatment and, unfortunately, rarely brings constant improvement. Surgical treatment is required in exceptional situations.
We present a case of a 74-year-old patient admitted to the Department of Neurosurgery to treat massive spinal stenosis at levels L2 to the level of the L4/5 intervertebral disc in the course of epidural lipomatosis of the spinal canal.
A few years before diagnosis, the patient reported increasing gait disturbances with neurogenic claudication. Before diagnosis, the patient was treated for 2 years for sciatica by a primary care physician. At the time of admission to the clinic, the patient had neurogenic claudication with a walking distance of up to 20 m, intensification of back pain: VAS 9/10 with a slight reduction of discomfort, with reduction of lordosis during forward...


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