Payer M, Van Schaeybroeck P, Reverdin A, May D
Department of Neurosurgery, University Hospital of Geneva, Switzerland.
Acta Neurochir (Wien). 2003 Apr;145(4):315-20; discussion 321. doi: 10.1007/s00701-003-0001-x.
Symptomatic spinal epidural lipomatosis (SEL) of the lumbar spine is a rare disease, often associated with steroid overload. Idiopathic lipomatosis is even much less frequent. Signs and symptoms depend upon the level and degree of nerve root compression. Diagnosis is best based on MRI. Weight reduction can be curative, however after failure of medical treatment or in severe cases surgical decompression should be performed.
Four patients with severe symptoms of lumbar spinal epidural lipomatosis were treated by surgical decompression. Patient history and neurological examination are described, diagnostic imaging is demonstrated, surgical treatment and outcome are documented. Different surgical techniques including laminectomy, interlaminar fenestration and lateral recess decompression were applied and are discussed.
All four patients improved after surgery. No surgical complications were observed. Even though limited to four cases this is the second largest series of operated idiopathic spinal epidural lipomatosis.
Surgical decompression was effective in improving symptoms in severe lumbar idiopathic spinal epidural lipomatosis.
腰椎症状性脊髓硬膜外脂肪增多症（SEL）是一种罕见疾病，常与类固醇过量有关。特发性脂肪增多症则更为少见。体征和症状取决于神经根受压的部位和程度。最佳诊断方法是磁共振成像（MRI）。减轻体重可能治愈该病，然而在药物治疗失败或病情严重的情况下，应进行手术减压。
对4例有严重腰椎脊髓硬膜外脂肪增多症症状的患者进行了手术减压治疗。描述了患者病史和神经学检查情况，展示了诊断性影像学检查结果，记录了手术治疗过程和结果。应用并讨论了包括椎板切除术、椎板间开窗术和侧隐窝减压术在内不同的手术技术。
所有4例患者术后均有改善。未观察到手术并发症。尽管仅4例病例，但这是第二大特发性脊髓硬膜外脂肪增多症手术系列报道。
手术减压对改善严重腰椎特发性脊髓硬膜外脂肪增多症的症状有效。
