Spinal epidural lipomatosis: case reports, literature review and meta-analysis.

BACKGROUND CONTEXT: Symptomatic spinal epidural lipomatosis (SEL), a rare cause of spinal cord compression, has most often been associated with exogenous steroid use. PURPOSE: Identify four associations with SEL, correlate the associated groups with level of disease and compare treatment with outcome data in these groups. STUDY DESIGN/SETTING: Case reports of three patients and analysis of 104 cases from the literature. PATIENT SAMPLE: Three patients from the senior author's practice. OUTCOME MEASURES: Not applicable. METHODS: The authors report three new cases of SEL not associated with steroid use. They review all available English literature and present a table of all 104 reported cases. RESULTS: The clinical course of three new patients is reported. CONCLUSIONS: Associated conditions are exogenous steroid use, obesity, endogenous steroid excess, and some remain idiopathic. Although SEL is a rare condition, our review of the literature reveals many more reported cases than previously thought. With increased awareness of this condition and improved imaging techniques, further studies of this disease should be undertaken.

Surgical evaluation and management of symptomatic lumbosacral meningeal cysts.

Sacral meningeal cysts are a fairly common finding in the workup of sciatica. In most instances, a cyst causes no symptoms. Occasionally, a symptomatic sacral cyst may present with chronic low back pain (radiculopathy), sensory loss in sacral dermatomes, perineal pain, or bowel or bladder dysfunction. Compared with computed tomography, magnetic resonance imaging shows meningeal cysts more often and allows better localization of sacral cysts. In this article, we present clinical guidelines that may be used to distinguish symptomatic cysts from asymptomatic cysts. We conclude that surgical treatment of a symptomatic cyst may include laminectomy with fenestration and imbrication of the cyst--or percutaneous treatment methods. Surgery for sacral meningeal cysts can lead to successful improvement of pain and function in activities of daily living in more than 80% of cases.

Coccygodynia: evaluation and management.

Coccygodynia is pain in the region of the coccyx. In most cases, abnormal mobility is seen on dynamic standing and seated radiographs, although the cause of pain is unknown in other patients. Bone scans and magnetic resonance imaging may show inflammation and edema, but neither technique is as accurate as dynamic radiography. Treatment for patients with severe pain should begin with injection of local anesthetic and corticosteroid into the painful segment. Coccygeal massage and stretching of the levator ani muscle can help. Coccygectomy is done only when nonsurgical treatment fails, which is infrequent. Coccygectomy usually is successful in carefully selected patients, with the best results in those with radiographically demonstrated abnormalities of coccygeal mobility.