To describe three cases of spinal epidural lipomatosis (SEL) and progressive myelopathy in patients with type 1 diabetes mellitus (DM1).

Spinal epidural lipomatosis (SEL) is a rare condition defined as pathological overgrowth of the normally present epidural fat within spinal canal.  SEL may cause myelopathy via compression of the spinal cord. SEL usually occurs in patients with Cushing’s disease, obesity or chronic corticosteroid therapy. Association between SEL and DM1 has not been previously reported.

Case series from a tertiary NYU MS Care Center center.

We desribe three patients (2 females and 1 male, ages 40-41) with long-standing DM1 who developed progressive myelopathy and were found to have thoracic SEL (extensive extradural T1, T2 hyperintense signal; biopsy confirmed as SEL in one case) with associated extensive abnormal cord signal. A comprehensive myelopathy workup for metabolic, infectious and autoimmune serologies, lumbar puncture and spinal angiography did not reveal an alternative explanation for myelopathy. One of the patients underwent a surgical decompression of SEL with subsequent clinical and radiologic improvement.

Patients with DM1 and myelopathy of unknown cause should be assessed for SEL. Timely diagnosis and appropriate intervention may forestall progression of neurological disability and even result in neurologic improvement. SEL should be considered a potentially reversible cause of progressive myelopathy.