Hi -
golantrevize-ga has provided a link to a very nice page that discusses
spinal lipomas of all shapes and varieties - including descriptions of
the various types of lipomas, epidemiology (what is thought to cause
them), and treatment options. The link again is
www.medscape.com/viewarticle/405673.
In summary, there are five types of fatty deposits in the spine, all
of which are treated surgically:
1) Lipomyelomeningocele - this is the most common type of spinal fatty
deposit - present since childhood, protruding through the back of the
spine, commonly causing tethering of the spinal cord (a condition in
which the cord is "stretched" often causing nerve pain, weakness, and
other neurological symptoms -
http://www.bcm.tmc.edu/pednsurg/disorder/tethered.htm).
2) Fatty Filum - this is similar to the type listed above - present
since childhood, represents malformation of the spinal cord, smaller
defect in the spine, fewer neurological complications (no tethering,
just a "mass effect" or "squeezing" of the cord by the fatty mass).
3) Intradural Spinal Lipoma - this type of fatty mass is within the
spinal canal, and within the protective layer of the spinal cord, the
dura. These are rare (<4% of spinal lipomas) and only cause problems
when they swell to press on the surrounding cord. They usually cause
problems in the second to third decades of life.
4) Epidural Lipomatosis - this type of fatty deposit is within the
spinal canal, but not within the protective membrane of the spinal
cord (the dura). It is not congenital, and can be found in
individuals who have taken large amounts of steroids or who are obese.
The fat in this case, can surround the spinal cord and squeeze it.
5) Spinal Angiolipoma - this is a type of tumor in which blood
vessels and fat cells abnormally proliferate to create a mass. These
have been found in the spine, but are rare.
As you mentioned that the person in question is 59 years old, it would
appear that the most likely cause is epidural lipomatosis (assuming
that this hasn't been present since the individual was a child).
Treatment for this condition is usually surgical to decompress the
spinal cord and prevent the fatty mass from pressing on the cord. If
the mass was caused by another factor (steroids or anti-retrovirals,
Cushing's syndrome), discontinuation of the medicine (or treatment in
the case of Cushing's) has shown some benefit, in some studies.
References:
A small site with a picture and suggested treatments - reduce steroids
(either as medication or produced in the body in patient's with
Cushing's syndrome), reduce weight, operate if the symptoms are
severe.
http://www.cc.nih.gov/drd/lipomatosis.html
Medical references:
A paper discussing the surgical options:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12014365&dopt=Abstract
A paper describing a case in which the fatty deposit was caused by
steroids, with improvement upon discontinuation of the steroids:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10844373&dopt=Abstract
Several questions in a forum on neurology and neurosurgery, with
several answers referencing medical literature for spinal lipomas:
http://www.medhelp.org/forums/neuro/archive/14768.html
http://www.medhelp.org/forums/neuro/messages/31056a.html
Let me know if you, if after reading my answer, require more specific
research on one of the particular topics that I have answered.
synarchy |
Clarification of Answer by
synarchy-ga
on
26 Sep 2002 01:50 PDT
Hi -
Failed-back syndrome is characterized by symptoms returning after
surgery to decompress the spine and remove herniated discs
(decompression is often part of a spinal fusion as well). Basically,
it is thought to be caused by excessive scar tissue formation in the
spinal canal (though not in the cord itself) that compresses the
spinal cord and nerve roots (much like the herniated disks and
malaligned vertebrae probably did before fusion). It's cause is not
well understood, but it is not uncommon, occuring in 10-40% of spinal
procedures.
This site seems to have a reasonable description of the syndrome:
http://www.spineuniverse.com/index.htm?http&&&www.spineuniverse.com/treatment/alternative/ag_chiro_surgfail.html
One other cause of fat deposits in the spine of patients whom have
been operated on is a fat graft. A fat graft is placed over the
protective covering of the spinal cord (the dura) between it and the
muscles of the back (which are now exposed to the dura because the
rear section of the vertebrae has been removed. This is commonly done
in an attempt to prevent scarring within the spinal canal, and,
hopefully avoid "failed-back" syndrome. However, sometimes these fat
grafts can shift, causing compression of the cord themselves.
A page describing the procedure of implanting materials to reduce
scarring:
http://www.mgh.harvard.edu/depts/hoj/html/articles17.html
There is also at least one report in the medical literature where
spine fractures were the result of osteoporosis from steroids, and
epidural fat deposits developed in the areas surrounding the
fractures:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10968549&dopt=Abstract
I hope that this helps to answer your question.
synarchy
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