Journal of neurosurgery. Case lessonsJan 26, 2026

Severe fat buildup around the lower spine improves after weight loss caused by tirzepatide: a case report

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Feb 1, 2026

Abstract

A 35-year-old man achieved approximately 60 pounds of weight loss after initiating tirzepatide therapy for spinal epidural lipomatosis.

Spinal epidural lipomatosis (SEL) is linked to obesity and can cause lumbar stenosis.
The patient experienced severe symptoms, including neurogenic claudication and functional decline.
MRI indicated multilevel lumbar SEL with severe spinal stenosis prior to treatment.
After one year of tirzepatide therapy, the patient showed marked symptom resolution.
Repeat MRI revealed near-complete regression of epidural fat, eliminating the need for surgery.
Pharmacological weight loss may provide a nonoperative option for patients with obesity-related SEL.

Simplified

BACKGROUND: Spinal epidural lipomatosis (SEL) is a rare disorder characterized by pathological accumulation of adipose tissue in the spinal epidural space, leading to signs and symptoms of lumbar stenosis. SEL is increasingly linked to obesity, and treatment requires surgical decompression if conservative measures fail. The role of modern pharmacological weight-loss agents in reversing SEL has not been previously described.

OBSERVATIONS: A 35-year-old man with severe, symptomatic lumbar SEL and class II obesity (BMI 37.8 kg/m) presented with progressive neurogenic claudication and functional decline. MRI revealed multilevel lumbar SEL with severe spinal stenosis. After counseling, the patient initiated tirzepatide therapy and achieved approximately 60 pounds of weight loss within 1 year. This was accompanied by marked symptom resolution and near-complete regression of epidural fat on repeat MRI, negating the need for surgical intervention.

LESSONS: This case demonstrates that pharmacological weight loss with agents such as tirzepatide may offer a viable, nonoperative alternative for patients with obesity-related SEL, particularly those who are not ideal surgical candidates. Validation in larger studies is needed to assess long-term efficacy and help guide patient selection for pharmacological versus surgical approaches. https://thejns.org/doi/10.3171/CASE25886.

Full Text

We can’t show the full text here under this license.

View Full Text ↗

Severe fat buildup around the lower spine improves after weight loss caused by tirzepatide: a case report

Abstract

Full Text

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the glp-1 therapies brief