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Epidural Lipomatosis – Why some Hernias Hurt more than Others

It has been known for long that a large part of the population have asymptomatic disc-herniations, but why is it that in some cases even minor herniations can cause severe pain?

A partial explanation for this is a phenomenon known as spinal epidural lipomatosis (SEL), which is a state where fat gets deposited around the outer sheet of the spinal-cord. This decreases the volume of the epidural space that normally separates this highly pain-sensitive tissue from the spinal discs and the vertebral arch, which means that small herniations have an increased potential to cause symptoms such as back-pain and sciatica.1)

Transverse MRI-section of a vertebral segment displaying SEL.

SEL is a form of ectopic lipid-deposition, and has shown to be related to the metabolic syndrome.2) I’ve covered the purpose and workings of this mechanism in the chapter on Histopathology in my book.


Man photo created by –

Per Bylund
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