Indirect decompression with lateral interbody fusion could be effective for lumbar canal stenosis due to spinal epidural lipomatosis: Two case reports

Abstract

Backgrounds: For the surgical treatment of lumbar canal stenosis (LCS) due to spinal epidural lipomatosis (SEL), several studies have reported direct decompression, including fat debulking. However, none of these studies have mentioned indirect decompression for SEL. Here we report two cases in which indirect decompression with lateral interbody fusion (LIF) was effective in treating LCS due to SEL. Case description: Case 1 involves a 71-year-old male with LCS due to SEL at the L3/4 and L4/5 levels without a history of steroid usage. Case 2 involves a 60-year-old male with LCS due to SEL at the L2/3, L3/4, and L4/5 levels, who had been medicated with prednisolone (2.5 mg/day) and methotrexate (6 mg/week) for the treatment of remitting seronegative symmetrical synovitis with pitting edema syndrome. After oblique lateral interbody fusion and posterior fusion with percutaneous pedicle screw, the patients’ symptoms disappeared immediately. Postoperative magnetic resonance imaging showed that the epidural fat had been successfully stretched, and the dura was decompressed. Conclusions: Indirect decompression with LIF could be a new surgical option for treating LCS due to SEL.

Keywords

• Spinal Epidural Lipomatosis
• Indirect Decompression
• Oblique Lateral Interbody Fusion