Spinal cord stimulator in patient with epidural lipomatosis

[painfre]

Have a motivated patient with failed back surgery and bilateral lumbar radiculopathy.
Although routinely, I do not ask for thoracic MRI before trial, requested in this patient, since I got enough time before scheduling a trial

MRI thoracic spine report showed compression fracture at T8 vertebral body and T9 vertebral body, diffuse posterior epidural fat deposition seen throughout thoracic spine most notably from T3-T9 which showed Diffuse multilevel thoracic canal stenosis resulting in marked overall volume of thecal sac and epidural spaces from T6-T9.
AP diameter is not provided.
Unfortunately, I cannot paste the MRI images here.

Any experience of spinal cord stimulator placement in patients with epidural lipomatosis causing stenosis. Thank you

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[lobelsteve]

email pics so I can post for you.
Epidural lipomatosis is not compressible. Talk to your surgeons about this fat vs subQ fat. I would not go above T9 for this patient.

 

[clubdeac]

Side note...anyone have any luck with decompression for their patients with lumbar spinal stenosis due to epidural lipomatosis? The surgeon where I'm at won't operate on it and I have little left to offer after epidurals. Guess I could go to stim but would rather have it decompressed before considering that. Thoughts?

 

[Ducttape]

Side note...anyone have any luck with decompression for their patients with lumbar spinal stenosis due to epidural lipomatosis? The surgeon where I'm at won't operate on it and I have little left to offer after epidurals. Guess I could go to stim but would rather have it decompressed before considering that. Thoughts?

Surgery Won't help.

Weight loss apparently really only way to reduce compressive symptoms with epidural fat...


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[Tapspatellas]

Surgery Won't help.

Weight loss apparently really only way to reduce compressive symptoms with epidural fat...


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And avoid steroids.

Had one decompressed and didn't do a thing

 

[Timeoutofmind]

And avoid steroids.

Had one decompressed and didn't do a thing

I dont even do ESIs for these people

Case reports of much worsening lipomatosis after have been published

 

[thecentral09]

Agree, recent fellowship grad here. Our teaching was give 1 ESI if they have epidural lipomatosis and if they have significant improvement it can provide a window for increased activity/weight loss. If fails then nothing more to do.