SEL – Spinal Epidural Lipomatosis – Say What?

MRA Templates (landscape)-Jan-12-2023-06-01-55-5397-PM

What, you may ask, is spinal epidural lipomatosis? In order to answer that question, let’s first define the word lipomatosis. According to the Merriam-Webster Dictionary, a lipomatosis is an abnormal condition characterized by localized or generalized deposits of fat. Epidural fat resides on top of the spinal cord’s epidural layer. It is soft and normally helps protect the spinal cord. It is most commonly found along the spine’s thoracic and lumbo-sacral regions.

What is Spinal Epidural Lipomatosis (SEL)?

A spinal epidural lipomatosis – or SEL – is a rare, space-occupying condition whereby an excess overgrowth of fat is found on or outside the epidural layer of the spinal canal. Accumulated epidural fat can impact the subarachnoid space and affect nerve movement within the thecal sac. As a reminder, the thecal sac is the membranous sheath that surrounds the spinal cord and contains the cerebrospinal fluid.

What Causes SEL?

SEL is most often associated with excess steroids in the body. The excess steroids could be endogenous, as in Cushing’s disease, or exogenous such as those used to treat SLE – systemic lupus erythematosus. SEL has also been linked, but is not limited, to hypothyroidism, morbid obesity and spinal stenosis. Some patients have been known to have cauda equina syndrome due to SEL. SEL was first identified in 1975 in a post-renal transplant patient.

What are the Symptoms of SEL?

SEL symptoms mimic those caused by lumbar disc herniation or lumbar spinal stenosis. Patients complain of low back pain, numbness, weakness, and cauda equina syndrome.

How is SEL Diagnosed?

After reviewing the patient’s physical complaints, most cases of SEL are diagnosed via a spinal MRI.

How is SEL Treated?

Though some cases of SEL are asymptomatic, treatment choices most often depend on the severity of any neurological deficits. Steroid-induced SEL can potentially be reversed by weaning the patient from their steroid medications; obesity-related SEL could be treated via weight loss. Surgical intervention may be required and could include (but is not limited to): intervertebral fusion, pedicle screw fixation, small laminotomy, endoscopically guided fat aspiration, fat debulking, instrumented posterolateral fusion, decompression laminectomy, and/ resection of the epidural adipose tissue.

Other Information

  • SEL appears to affect men more than women.
  • SEL patients can also present with cauda equina syndrome (CES). Bowel and bladder issues are the most common presenting symptom in addition to the typical SEL symptoms of back and leg pain.
  • The thoracic spine is the most commonly involved area, accounting for 58 – 61% of cases; lumbar involvement is attributed to 39 – 42% of cases.
  • It is believed that female patients are more likely to have lumbar SEL.

What ICD-10-CM Code Number is Assigned to SEL?

E88.2 – Lipomatosis, not elsewhere classified

Lipomatosis NOS

Category code E88 is “Other and unspecified metabolic disorders.” There is a “Use additional” code note that instructs coders to “Use additional codes for associated conditions.” If the physician has documentation linking the SEL to conditions such as Cushing’s disease, SLE, spinal stenosis or other disorders, additional ICD-10-CM code/codes should be assigned.

What ICD-10-PCS Code Number(s) is/are Assigned to the Procedure Used to Remove/Treat SEL?

Depending on any identified cause, there are a variety of ways to treat SEL. Treatment may be as simple as reducing or eliminating steroids if the SEL was steroid-induced, or losing weight if obesity is a factor. In these instances, there would be no PCS code(s) assigned. When surgical intervention is the treatment of choice, there is no “one choice fits all” type of surgery. Coders will need to follow the basics, such as reading the operative/procedure report to determine what procedure was actually performed and assign the PCS code(s) as appropriate to the documentation.


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