{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T18:13:27Z","timestamp":1770747207907,"version":"3.49.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T00:00:00Z","timestamp":1770681600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize the presentation, diagnostic strategy, and postoperative recovery patterns in a patient with lumbar spinal stenosis (LSS) complicated by spinal epidural lipomatosis (SEL), and to evaluate the role of selective nerve root block (SNRB) in guiding staged minimally invasive decompression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed the clinical course of a 65-year-old man presenting with neurogenic claudication and right lower extremity numbness after a course of inhaled glucocorticoids. Preoperative assessment included radiography, computed tomography (CT), and magnetic resonance imaging (MRI), which demonstrated degenerative central canal stenosis at L4\/5 and epidural lipomatosis at L5\/S1. Because imaging findings were multilevel and symptom dominance was unclear, SNRB localized the symptomatic level and guided staged arthroscopy-assisted uniportal decompression. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), SF-36 quality-of-life scores, walking tolerance, and neurological examinations during 4 months of follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SNRB identified L4\/5 as the primary symptomatic level, supporting initial targeted decompression. Following Stage 1 decompression at L4\/5, neurogenic claudication and motor weakness improved rapidly, with VAS decreasing from 7 to 4 and ODI improving from 52 to 38. Persistent plantar numbness prompted Stage 2 decompression with excision of excessive epidural fat at L5\/S1, after which VAS further decreased to 2 and ankle plantarflexion strength improved relative to baseline. At the final follow-up, ODI improved to 20 and the SF-36 composite score increased from 32.6 to 70.8. Walking tolerance markedly improved, only mild plantar paresthesia persisted. No perioperative complications or postoperative instability were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This case suggests that SEL may trigger or unmask clinical symptoms of degenerative LSS and highlights distinct recovery trajectory between focal degenerative stenosis and diffuse epidural fat\u2013related compression. SNRB-guided staged minimally invasive decompression enabled precise level selection and favorable functional outcomes, underscoring its value in managing multilevel lumbar pathology complicated by SEL.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1770604","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T06:47:30Z","timestamp":1770706050000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Lumbar spinal stenosis exacerbated by spinal epidural lipomatosis: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Yide","family":"Fang","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Longhua Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenghang","family":"Bian","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Longhua Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengyi","family":"Tong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Longhua Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinhai","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Longhua Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen","family":"Mo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Longhua Hospital, Affiliated to Shanghai University of Traditional Chinese Medicine","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,10]]},"reference":[{"key":"B1","first-page":"350","article-title":"Lumbar spinal stenosis: diagnosis and management","volume":"109","author":"Webb","year":"2024","journal-title":"Am Fam Physician"},{"key":"B2","doi-asserted-by":"publisher","first-page":"249","DOI":"10.3238\/arztebl.m2025.0056","article-title":"The diagnosis and treatment of degenerative changes of the lumbar spine","volume":"122","author":"Beyer","year":"2025","journal-title":"Dtsch Arztebl Int"},{"key":"B3","doi-asserted-by":"publisher","first-page":"91","DOI":"10.17219\/acem\/163357","article-title":"Degenerative disease of the spine: how to relate clinical symptoms to radiological findings","volume":"33","author":"S\u0105siadek","year":"2024","journal-title":"Adv Clin Exp Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"25571","DOI":"10.52965\/001c.25571","article-title":"Spinal epidural lipomatosis: a comprehensive review","volume":"13","author":"Walker","year":"2021","journal-title":"Orthop Rev (Pavia)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"322","DOI":"10.3390\/diagnostics13020322","article-title":"Could spinal epidural lipomatosis be the hallmark of metabolic syndrome on the spine? 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