Case Report: Segment-specific minimally invasive surgical management of lumbar spinal epidural lipomatosis with adjacent-level degenerative stenosis.

BACKGROUND

Spinal epidural lipomatosis (SEL) is characterized by excessive accumulation of unencapsulated adipose tissue within the epidural space and may cause clinically relevant neural compression. When SEL coexists with degenerative stenosis at an adjacent lumbar level, the involved segments may require different decompression and stabilization strategies.

CASE PRESENTATION: A 56-year-old man presented with chronic low back pain, progressive bilateral lower-extremity pain and numbness, and neurogenic claudication. Lumbar magnetic resonance imaging demonstrated excessive posterior epidural adipose tissue at L3-L4 with marked dural sac compression, together with degenerative central and lateral recess stenosis and Meyerding grade I degenerative spondylolisthesis at L4-L5. A single-stage, segment-specific minimally invasive procedure was performed. Tubular unilateral laminotomy with bilateral decompression and debulking of epidural adipose tissue were performed at L3-L4, whereas decompression, transforaminal lumbar interbody fusion, and bilateral pedicle screw fixation were performed at L4-L5. The operative time was 150 min, and estimated blood loss was 100 mL.

OUTCOME: Early postoperative axial CT demonstrated the L3-L4 laminotomy and enlargement of the osseous canal. Side-by-side sagittal T2-weighted images obtained in comparable planes showed reduced posterior indentation of the dural sac at L3-L4 after surgery. At the 12-month follow-up, comparison with the early postoperative radiographs showed no obvious interval hardware displacement or loss of L4-L5 alignment. Plain radiographs did not establish solid interbody fusion.

CONCLUSION

This case illustrates a segment-specific minimally invasive strategy for adjacent lumbar pathologies with different treatment requirements. Decompression without fusion may preserve an otherwise stable SEL-involved segment, whereas fusion at an adjacent degenerative level should be based on patient-specific clinical, radiological, and biomechanical considerations. Comparative safety or effectiveness cannot be inferred from a single case.