So you have a patient who typically does well with epidural steroid injections. Their most recent MRI shows increased epidural lipomatosis. Do you continue to do epidural injections? Are any steroids less of an issue for this than any other? Or is it a nonissue altogether?
Epidural lipomatosis
- Thread starter macman
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Heard about this but never actually seen it. Strange since steroid causes fat necrosis subQ. If it's increased because he gained weight, I wouldn't hesitate. If it seems to be from injections I'd probably stop and try something different or surgical consult. What's the pathology?
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Depends on amount of stenosis. If mild then may use lower dose or wait longer period between injections while continuing to monitor. For severe, I decline repeating injections and offer stim/surgical referral. I usually counsel risks/benefits regardless.
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you also consistently lie in your clinic notes to get by with whatever you want, so there's that
To get my patients the shot they need? To make sure the LOL with stenosis doesnt have to do 2 months of PT before her ESI? Yeah, ill bend the truth.....
But that has nothing to do with this conversation. Just a poorly executed potshot.
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Sure buddy 😉
I would think acgme fellowship would mean all those who completed have magical ways to treat any painful condition that doesn’t involve..what’s that they said, a 22 or 25 gauge needle..maybe there is a stim indication for lipomatosis?? Maybe there’s a medication option that only certain blessed individuals know through their cancer pain rotation??
Make a legitimate medical point or just stop typing.
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for some reason it's so gratifying
Right. Its called being a troll.
I admit that i had some trollish tendencies. I grew out of it, tho.
Seriously, watch how ducttape goes about his business. You dont need to agree with him, but even when he is disrespected, he responds with grace and class.
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I’ve seen the canal look trefoil just from fat—not injecting that.
There’s nothing wrong with exercising creative writing skills when some bureaucrat dreams up some criteria that they demand the patient do before an inje….wait is this the open forum?
There’s nothing wrong with exercising creative writing skills when some bureaucrat dreams up some criteria that they demand the patient do before an inje….wait is this the open forum?
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Is do injections for temporary relief and state importance of weight loss. PCP referral for weight loss with meds.
Just like fat in your stomach, epidural lipomatosis also goes down with diet and exercise
Just like fat in your stomach, epidural lipomatosis also goes down with diet and exercise
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Studies showing this?
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That’s just to get insurance auth though right?
I fib in my notes too. I always say the patient that came in with a hot radic and 10/10 pain failed 6 weeks of home exercise to get done what I think the patient needs.
If insurance prior-auth non-sense is the Matrix, I consider us the crew of the Nebuchadnezzar.
With regards to the liopmatosis, back off the steroids, referral to bariatrics or education on your diet of choice with weekly check-ins (which is billable) to make sure they are on the right path. Many Google search pubmed results say the same. (They also say surgery helps)
This is the way.
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Spinal Epidural Lipomatosis: Weight Loss Cure - PubMed
A 47-year-old male patient presented at our neurosurgery unit with neurogenic claudication symptoms. The patient had a history of low back pain and lower extremity pain for 2 years. He had a body mass index of 38. Magnetic resonance imaging of the lumbar spine demonstrated severe stenosis due to...
pubmed.ncbi.nlm.nih.gov
Drastic Weight Reduction Decrease in Epidural Fat and Concomitant Improvement of Neurogenic Claudicatory Symptoms of Spinal Epidural Lipomatosis - PubMed
Drastic Weight Reduction Decrease in Epidural Fat and Concomitant Improvement of Neurogenic Claudicatory Symptoms of Spinal Epidural Lipomatosis
pubmed.ncbi.nlm.nih.gov
Spinal epidural lipomatosis due to obesity presenting with back and leg pain and weakness successfully treated with weight loss
Spinal Epidural Lipomatosis (SEL) is an uncommon but previously characterized ailment typified by excessive overgrowth epidural adipose tissue. This o…
This one isn't hard for face validity. I wouldn't inject steroids in stenosis secondary to lipomatosis as the surgical fix to that is brutal.
Inject saline as the data are just as good without the risk.
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all the surgeons locally will not do surgery for epidural fat.
1. it is hard to get out
2. surgery poses other issues such as post laminectomy syndrome
3. you cannot excise all the fat and apparently the lipomatosis recurs. fat cells are not like other cells. they dont "replicate". the ones remaining will just expand.
1. it is hard to get out
2. surgery poses other issues such as post laminectomy syndrome
3. you cannot excise all the fat and apparently the lipomatosis recurs. fat cells are not like other cells. they dont "replicate". the ones remaining will just expand.
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I have had a few patients get surgery for this. They have done well. Only issue is the fat adheres to dura so it is a technically challenging surgery with relatively high risk for dural tear.
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This article on epidural lipomatosis is very relevant to the discussion: Is There an Association Between Lumbosacral Epidural Lipomatosis and Lumbosacral Epidural Steroid Injections? A Comprehensive Narrative Literature Review
