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Sagittal MR image of the lumbar spine demonstrated severe foraminal stenosis at Lt. L4/5/S1.
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Lt. L4/5/S1 (Fig. 1).
A flexible probe under endoscopic view was used to confirm the decompression by mobilizing the Lt. (A) L4/5 and (B) L5/S1 exiting nerve roots.
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Lt. L4/5/S1 (Fig. 2).
Postoperative MR image showed enlarged foramen at Lt. L4/5/S1.
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Lt. L4/5/S1 (Fig. 3).
(A) Sagittal and (B) transverse MR images showed focally progressed epidural fat posterior to the L5 body, causing tight spinal canal stenosis and compressing the cauda equina.
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MRI was checked at five months postoperatively and showed focally progressed epidural fat posterior to the L5 body, causing tight spinal canal stenosis and compressing the cauda equina (Fig. 4).
The MR images performed before and after L4/5/S1 foraminotomy surgery did not show the spinal epidural lipomatosis.. A: Sagittal MR image performed before L4/5/S1 foraminotomy surgery.. B: Sagittal MR image performed after L4/5/S1 foraminotomy surgery.. C: Sagittal MR image performed at 5 months after L4/5/S1 foraminotomy surgery.
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The MRI performed before and after L4/5/S1 foraminotomy surgery did not show the SEL (Fig. 5).
Endoscopic views (A) before and (B) after epidural lipomatosis removal surgery.
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After removal of lipomatosis via endoscopic posterior decompression at L3/4/5 (Fig. 6), his symptoms improved.