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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 33506
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have an MRI report that states I have "prominent epidural

Customer Question

Hi. I have an MRI report that states I have "prominent epidural lipomatosis L5 S1 . My rheumatologist ordered the MRI to r/o ankylosing spondylitis. I test positive for HLA B27 and my sister has AS. The MRI showed no spondylitis. My doctor never mentioned the SEL. Couldn't that be causing my lower back and left hip/leg pain? I have had SI joint pain, left groin pain, front of left thigh pain and muscle weakness for 3 years. The MRI was done 13 months ago. I was reading through my medical records today and noticed this sentence then googled SEL.
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.


I am Dr. Arun and will be helping you today.

I am sorry that your question was unanswered for long.

The prominent epidural lipomatosis can cause all of your symptoms as it can be responsible for the pinching of the nerves. Spinal epidural lipomatosis is a known entity to cause pinched nerves and usually surgery is recommended for the treatment for large lipomatous tissue. Epidural adipose (fat) tissue that has a thickness greater than 7 mm has been considered as the diagnostic criterion for SEL Surgical intervention, with decompressive laminectomy and resection of epidural adipose tissue, is successful in majority of these patients. Smaller SEL less than 7 mm can be benefited by weight loss and physical therapy.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Customer: replied 1 year ago.
Why did my doctor not discuss what this condition is with me?? He never even mentioned the finding. Basically, all he said was you have no evidence of AS. You do not have any physical problems that cause your pain. I can not help you. I am now discontinuing my treatment of you. What kind of doctor do I call now?
Expert:  Dr. Arun Phophalia replied 1 year ago.

You may consider calling a neurologist or a MD in physical medicine and rehabilitation. Many doctors may miss the findings when they are just focused to look for a diagnosis. With your family history and HLA B 27 being positive; the doctor when did not find the corroborative findings for Ankylosing spondylitis; he did not give any significance to the other medical imaging finding. This is my explanation; but it is difficult to say and reason about other doctor.

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

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Thank you.

Wishing you all the very best in life.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited for my work.

Now, I will provide an Additional Service offer so that you have this option available on your question list to get a hold of me directly in the future.

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Thank you.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Following measures would be helpful;

1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

a) Avoid activities which increases the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor.

You can start the following exercises;

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

This is a slide show for the exercises (you can pick up your own set, which suits you);

You can consult following specialists (apart from your GP);

a) Orthopedist

b) Neurologist

c) MD in Physical medicine and rehabilitation