PMC6217886_01
(a) and (b) Minimal spondylotic changes seen in plain radiography of the spine with no features of gross instability.
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Plain radiography of the lumbar spine did not show any gross feature of instability and was inconclusive (Figure 1).
(a and b) T2- and T1-weighted sagittal MRI images showing a large epidural intraspinal posterior epidural lesion with hyperintense signals in the periphery and hypointense signals at the center at the L2-L3 level with severe thinning of the thecal sac. The hyperintense region becomes hypointense in the fat-suppressed sequence (c) confirming the presence of fat in the periphery and bone tissue in the center of the lesion. (d and e) Axial images demonstrating adjacent epidural fatty hypertrophy contributing to stenosis in addition to the lesion reducing the caliber of dura to near nonexistence.
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The cauda equina was severely compressed and was almost not visible (Figure 2).
(a) Sagittal CT image shows the huge osseous lesion causing severe compromise of the spinal canal. (b and c) Axial and coronal images demonstrating the attachment to the right L2 inferior articular process.
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Owing to the heterogeneous signal intensities, computerized topography (CT) was performed which revealed the presence of an osseous lesion attached to the right L2 inferior articular process causing severe secondary canal stenosis (Figure 3).
(a) Intraoperative microscopic view image:bone window created around the lesion. (b) Adherent soft tissue being removed from beneath the lesion. (c) En bloc removal of the lesion. (d) Gross appearance of the lesion appearing grey white and measuring 2 cm x 1.5 cm x 1.5 cm. (e) Histopathological image showing mature well-capsulated adipose tissue with intermittent osteoid. (f) Lamellar osseous tissue adjacent to adipose tissue visible on higher magnification. (g) Plain radiography following complete excision of tumor and fusion at the L2-L3 level.
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The lamina was thinned out using a burr to avoid further insult to the dural sac, and then using a Kerrison ronguer, laminectomy was completed all around the lesion under microscopic guidance (Figure 4). It was greyish white in color and firm to hard in consistency (Figure 4(d)). Histopathological examination revealed the presence of bone, cartilage and ligamentous tissue, and zones abutting all these composed of mature adult-type encapsulated adipose tissue (Figures 4(e) and 4(f)).