Lumbosacral Spinal Epidural Lipomatosis Causes Low-Back and Leg Pain and Lower-Limb Numbness

If I had not personally suffered from low-back and leg pain for more than three years, I would never have imagined that thickening of the epidural adipose tissue anterior to the thecal sac at the human lumbosacral spine could cause back and leg pain and numbness in the lower limbs.

This is a very rare disease, so much so that most orthopedic surgeons have never even heard of it. In the second half of 2016 I began to feel pain and discomfort in my right buttock, which gradually spread to pain in my right lower back, my right leg, a right ankle that sprained very easily, and frequent unexplained bruising on my right knee; when the weather turned windy or rainy, my leg felt numb and uncomfortable.

I tried many ways to relieve it. The first thing I used was moxibustion, which had some effect—each time it hurt, moxibustion eased the pain a little but could not cure it. My lower back and legs remained sensitive to cold and wind. Later I went to orthopedics and saw several doctors who used manipulation and acupuncture for physical therapy; this also helped somewhat, but was far from a cure. Each treatment improved the symptoms briefly, only for them to recur soon after. Usually the effect of one treatment lasted no more than two or three days, and sometimes the therapy even worsened my symptoms.

I had thought I would have to endure back and leg pain for the rest of my life, so I resigned myself to learning to live with it. The hospital had nothing better to offer; several examinations showed a normal lumbar spine, normal alignment, no hyperostosis and no signs of bone destruction. The spinal cord was normal too. Only once, on an AP and lateral pelvis X-ray taken at the Beijing Massage Hospital, were there some inflammatory hyperplastic tissues at the sacroiliac joint. Treatment there gave me brief relief, and at the time I thought it might be cured. But before long things went wrong again.

I then decided to give up treatment and learn to live in peace with my back and leg pain—as long as I did not walk too much, my back and legs could basically function normally.

But a colleague of my wife's had once had back and leg pain too, and recovered after a year of massage and traction at the Air Force General Hospital in Beijing. My wife insisted that I go to the Air Force General for a period of treatment; she even took leave from work and forced me to set aside my work to go there with her.

This time I got an ordinary outpatient ticket, and a young doctor received me. Despite a pile of examination reports, including an MRI of the lumbar intervertebral discs, this young doctor judged from my symptoms that this was not a sacroiliac problem. He considered the sacroiliac joint a minor issue that could not cause all the symptoms I described, so he ordered me to have another MRI of the lumbar spine.

To be honest, I resented this kind of repeat examination, and an MRI appointment at the Air Force General required more than a month's wait—I simply could not wait that long. In the end I chose to have the MRI at the hospital's affiliated branch. This MRI showed thickened epidural adipose tissue anterior to the thecal sac at my lumbosacral level, about 8 mm. This condition has a specific medical term: spinal epidural lipomatosis, abbreviated SEL.

The doctor who wrote the MRI order was unfamiliar with this condition. After the results came out, I registered at this affiliated hospital and asked an orthopedic doctor to look at the films. From his bewildered expression I could tell he knew very little about this disease. He could only prescribe some

After getting home I looked it up and learned that this is a relatively rare disease, mostly associated with long-term use of exogenous steroidal hormones and primary Cushing's syndrome, though it can also occur in simply obese patients; it is more common in men. Abnormally proliferating adipose tissue compressing the spinal cord and nerve roots causes symptoms such as low-back and leg pain and lower-limb numbness.

The diagnostic criteria for this disease are as follows: after excluding disc herniation at the corresponding level, spondylolisthesis, epidural hematoma, epidural tumor and other lesions, and with no history of surgery or radiotherapy at the corresponding level, diagnosis is made by: 1. medical history and physical examination matching the involved level; 2. MRI showing epidural fat thickness greater than 7 mm at the affected level; 3. epidural fat thickness occupying more than 50% of the canal diameter; 4. BMI greater than 27.5 kg/m²; 5. a long history of hormone use, or suffering from related endocrine or metabolic disease, and so on. Among these, criterion 1 plus either 2 or 3 is sufficient for a definitive diagnosis. Criteria 4 and 5 are classification criteria: meeting 5 is hormone-induced secondary SEL; meeting 4 but not 5 suggests obesity-related SEL; meeting neither, with no history of chronic disease medication, suggests idiopathic SEL.

By these criteria I meet 1, 2 and 4, but not 5, so I have obesity-related spinal epidural lipomatosis. Treatment is generally surgical, but patients who cannot tolerate surgery and whose symptoms are not especially severe can be managed conservatively with pain relief, bed rest and weight loss.

After getting home I looked up the relevant literature based on the MRI results. I saw that several hospitals had treated a few similar patients, basically all like me, who had for years been misdiagnosed and treated for common conditions like lumbar disc herniation, with unsatisfactory results. Some patients with more severe symptoms than mine had surgery to remove the thickened epidural fat, after which their symptoms disappeared.

I chose conservative treatment for myself. I did not need painkillers, and I did not need bed rest. Once the MRI showed that my epidural fat exceeded 7 mm, I understood exactly what I needed most.

In recent days I have combined dieting with exercise to address my problem, strengthening my abdominal and lower-back exercise. Because my problem was mainly caused by too much desk work, this week I am not writing articles and am reducing the time I spend reading at my desk. I have done a series of exercises targeted at abdominal obesity and the sciatic nerve: ab wheel rollers, sit-ups, push-ups, dumbbell lifting and squats, glute bridges, and leg stretches.

After a week of exercise, the clinical symptoms almost completely disappeared. I threw away the ankle brace and can walk normally. I threw away the lumbar support belt and my lower back no longer hurts; the numbness in my thighs when the weather changed is gone; and I have lost four jin—I am not especially obese, with only a slightly high BMI.

During this period Beijing had a snowfall and two strong windstorms, and I even climbed Fragrant Mountain in the snow. None of my previous back pain, leg pain or leg numbness recurred. I had thought I might be troubled by "old cold legs" for the rest of my life, but now it seems I have hope of a full recovery.

Whether this disease is truly rare or simply easily mis- and missed in outpatient clinics, I find it hard to judge. I only have a vague feeling that, given modern lifestyles, many people have a high BMI and, like me, have long done desk work; their problems of back and leg pain and lower-limb numbness may also be related to excessive epidural fat. It is just that, like me, they have undergone repeated hospital examinations that failed to detect it. After all, the doctors doing the examinations are human too, and they can easily overlook this finding when reading films. These past three-plus years I was, one might say, wrongly treated under a misdiagnosis.

I also once treated myself according to the TCM concept of "bi syndrome," and consulted doctors I knew who specialized in treating bi syndrome, but the effect was not obvious. For three years I could only rest and conserve myself, not daring to exercise much, because exercise undertaken before the cause was clear always worsened my condition. Once the diagnosis was clear, without any expert's guidance I myself found the solution—no medication needed, just correct, targeted exercise quickly relieved the condition. If a patient instead has a lumbar injury rather than epidural lipomatosis, these exercises must be undertaken with great caution.

I am writing down this experience in the hope it may be of some reference value to patients with back and leg pain and lower-limb numbness, and may also help some orthopedic doctors and medical workers engaged in massage and tuina. Human lifestyles keep changing, and the spectrum of human diseases changes with them; diseases that were rare in the past may be common today.

At the same time I hope that friends who, like me, have long done desk work will exercise more and not let fat accumulate around their waist and abdomen—it really does cause many health problems.

I also ask my readers for your understanding. I am changing my lifestyle and working habits, reducing desk work and increasing exercise to improve my physical condition. So articles will not be updated as frequently as before. Years of burying myself in old texts to research TCM anti-cancer treatment have cost me my own health. Henceforth I will balance my various tasks so that my health is not compromised.