0:01

When we consider those entities that are located in the epidural

0:05

space, and particularly in the posterior epidural space,

0:09

we have to consider the diagnosis

0:11

of epidural lipomatosis.

0:13

Epidural lipomatosis may be present de novo or

0:17

may be associated with obesity or steroid use.

0:21

Its importance is that it may contribute to spinal stenosis.

0:26

While it's relatively rare for epidural lipomatosis, in and of

0:30

itself, to cause spinal stenosis leading to a myelopathy.

0:34

If you combine it with degenerative disc disease

0:37

or osteophytes, or other entities,

0:40

it will contribute to the patient's spinal stenosis.

0:44

On this example, we have a T2-weighted scan,

0:48

and we note that the bright signal intensity fat in the

0:51

posterior epidural space is greater than 50%

0:55

of the overall canal width on the sagittal scan.

1:00

This is demonstrated also on the axial scan that all

1:04

of this tissue here, which is the fat, is as wide as,

1:09

if not wider than the entire thecal sac,

1:12

including the spinal cord.

1:14

So this may lead to even compression of the thecal sac or

1:19

the spinal cord. But usually what we see is, for example,

1:23

a degenerative disc that is pushing on the cord and it's

1:27

constrained by the posterior epidural

1:30

fat leading to the myelopathy.

1:32

Occasionally this will be in an eccentric location,

1:36

this one a little bit more on the

1:37

left side than the right side.

1:40

And you can see that it may lead to thinning of the contrast

1:43

column at the level at which the epidural

1:45

lipomatosis is the worst.

1:47

Epidural lipomatosis is predominantly an entity that

1:51

we see in the thoracic spine,

1:53

relatively rare in the cervical spine and the

1:57

lumbosacral region being intermediate.