What is a spinal lipomatosis?

If you touch your body and press it you may feel small nodes under your skin. These nodes are often lipomas, which is a benign formation of adipose tissue that usually causes no discomfort. It is therefore also called a fat tumor. On the basis of lipomas there is the term lipomatosis (Greek: lipos = fat; -om = tumor; -ose = chronic progressive disease). Lipomatosis can affect different regions of the body. In some cases, these nodes can be found in sensible areas of our body like the epidural space: that is found in the spinal canal area but outside the spinal cord space. This area usually contains adipose tissue, loose connective tissue, veins and lymphatics. We are talking about spinal lipomatosis when this fatty tumor is found in the spinal canal. With the widespread release of fat cells, the spinal nerves can be crushed together causing compression of the spinal canal and consequently: discomfort.

There are several causes for a spinal lipomatosis

Despite international research, modern science knows relatively little about the causes of spinal lipomatosis. Their occurrence can have different causes. They appear often without any obvious causes; so idiopathic.

Other causes include:

  • Cortisone intake
  • Cushing syndrome: The clinical picture of Cushing's syndrome is the result of a pathological increase in the production of the adrenal gland hormone cortisol. The vast majority of Cushing's disease is caused by a benign tumor in the pituitary gland, resulting in overproduction of the adrenocorticotropic hormone (ACTH). This ACTH then stimulates the adrenal hormone production and thus leads to an increase of cortisol in the blood.
  • Obesity. In fact, a relationship between overweight (obesity) and various pre-existing conditions is observed. These include above all diabetes and an elevated uric acid level.
  • Patients who can successfully overcome an organ transplant and now lead a second life are also at risk. Why? Because these people take medications (corticosteroids) to attenuate the immune system, which in turn can have treacherous side effects.
  • The cause of lipomatosis as an inherited disease in which lipomas are common and generally called neurofibromatosis should not be underestimated. Neurofibromas and lipomas grow so pronouncedly that sometimes they affect the entire body of the sufferer.

Symptoms of spinal lipomatosis - similar to a herniated disc

This disease can be asymptomatic. In some cases back pain can be felt with radiations in the legs or arms, possibly accompanied by muscle weakness, sensory disturbances or cramps; these symptoms are similar to those of a herniated disc or spinal stenosis. Some patients complain of vegetative disorders, such as incontinence but also paralyzes and rectal disorders.

Diagnosis of spinal lipomatosis - magnetic resonance imaging (MRI) is part of diagnostics

Like always, there is no diagnosis without a deep conversation between the doctor and the patient. If pain, obesity, diabetes and possibly organ transplantation are confirmed – which means a synopsis of symptoms and complaints - the specialist may suspect a spinal lipomatosis but … just suspect, because the final word is given to the magnetic resonance imaging (MRI). In this imaging of the spine, an increase in epidural fat tissue can be detected as well as soft tissues such as connective and fatty tissue, but also muscles.

Therapies - lose weight or operate

If a spinal lipomatosis is not treated, there is a high risk that it will progress. With the therapies there are several possibilities. Put simply, one could say: lose weight or operate!

The weight reduction should be sought, especially if it is more or less obvious that the strong overweight has triggered the problem or promoted it. It may also be useful to softly interrupt cortisone medication. However, your specialist must make a risk-benefit assessment. If the lipomatosis causes symptoms, an operative volume reduction is necessary. This is done as part of a microsurgical operation accompanied by an absolutely necessary operation for unbearable pain and limitations, paralysis and bladder and rectal disorders.

Positive prognosis

The patient has a good prognosis if, as a result of weight reduction, the spinal lipomatosis does not spread further or if the lipoma was successfully removed during surgery.

Dr. med. Munther Sabarini

Author
Dr. med. Munther Sabarini
Specialist in Neurosurgery

Hans-Heinrich Reichelt

Co-author
Hans-Heinrich Reichelt
Chief Editor of Medizin für Menschen

The Avicenna Clinic in Berlin is always willing to help you

Since the year 2001, the Avicenna Clinic is based in Berlin. Our doctors have at least 25 years of international experience in their respective fields (neurosurgery, spinal surgery, anesthesia, and orthopedics).

If you have severe back pain, a herniated disc or a suspected herniation, please contact us using the following information:

Avicenna Clinic
Paulsborner Str. 2
10709 Berlin

Telephone: +49 30 236 08 30
Fax: +49 30 236 08 33 11
E-Mail: info@avicenna-klinik.de

You can call anytime, write an e-mail or fill out a callback form. Each patient then gets an appointment with a doctor of our clinic, who is a spine specialist (neurosurgeon). Based on MRI images (brought or made in our clinic) and on an in-depth examination, the doctor will discuss with you all the different therapy options or possibly surgery. You can also use our specialists only to obtain a (second) opinion.

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