Fact-sheet: Epidural lipomatosis


Updated on 04/30/2026 at 10:40 AM

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Definition

Rare condition characterized by an abnormal accumulation of fat in the epidural space compressing the dural sac.

Clinical features

Rarely symptomatic.

Occasionally: radiculopathy, neurogenic claudication, spinal cord compression

Causes:

  • long-term corticosteroid therapy
  • Cushing syndrome
  • epidural corticosteroid infiltration
  • obesity
  • Scheuermann disease
  • post spinal surgery
  • idiopathic

Male predominance.

CT

Fat-density mass (negative density between -50 and -150 HU) filling the epidural space and compressing the dural sac.

MRI

Reference examination

  • Enlargement of the epidural fat > 7 mm (normal anteroposterior diameter = 3-6 mm)
  • Homogeneous fat signal, hyperintense on T1 and T2, suppressed on FAT SAT
  • Compression of the dural sac: compression of the cauda equina nerve roots
  • Spinal cord compression with possible cord suffering, hyperintense on T2

Management

Conservative treatment: weight loss (diet) and reduction/discontinuation of corticosteroids if causative.

In case of failure or neurological deficit: consider surgical decompression (laminectomy with fat excision).

Classification

Classification (Grade according to Borré et al.), based on the measurement of posterior fat on MRI, often combined with the free space within the canal:

  • Grade 0: Normal fat thickness.
  • Grade 1: Moderately increased epidural fat.
  • Grade 2: Marked epidural fat, with moderate to severe stenosis, often symptomatic

Differential diagnosis

  • Disc herniation
  • Epidural fatty tumors: lipoma, liposarcoma (rare in the epidural space)
  • Epidural hematoma