Case Report: Electrophysiological characteristics of the pelvic floor in spinal epidural lipomatosis.
Jiaqian Li, Bin Chen, Hong Jiang and 2 others
PMID 41189727WHAT IT FOUND
In one young man with saddle pain and urinary retention, pelvic floor electrophysiology detected nerve damage months before MRI confirmed spinal epidural lipomatosis.
The sympathetic skin response was the earliest abnormality. This case report describes the findings in one person, not a pattern of efficacy.
Key findings
01The patient's initial electrophysiological abnormalities were restricted to the sympathetic skin response of the pudendal nerve and prolonged bulbocavernosus reflex latency, occurring before somatosensory evoked potential changes were detected.
02Three months later, repeat testing revealed progression to abnormal dorsal penile nerve somatosensory evoked potentials and neurogenic damage to the urethral sphincter, prompting MRI which identified spinal epidural lipomatosis at L5/S1.
03The authors suggest the pudendal nerve sympathetic skin response may be a sensitive early indicator of nerve injury in this condition, recommending its use in patients with related symptoms to aid early diagnosis.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a single case report, so findings cannot be generalized to other patients. The patient received multiple concurrent treatments (shock wave, electroacupuncture, biofeedback, TMS) during the second hospitalization, making it impossible to attribute any outcome to a specific intervention. The patient discontinued treatment after 10 days due to emotional fluctuations, so long-term outcomes of the rehabilitation program are unknown. The diagnosis relied on electrophysiological changes preceding MRI confirmation, which is a rare sequence; typical SEL diagnosis relies primarily on MRI.
Declared interests
The authors declare no financial support was received for the research or publication of this article.
The easy way to misread this
Do not assume that pelvic floor electrophysiology is a standard or validated screening tool for spinal epidural lipomatosis in the general population. This is a single case where the sequence of test abnormalities (SSR then BCR then SSEP) preceded the MRI diagnosis. The treatment provided was multimodal and discontinued early, so no conclusions can be drawn about the efficacy of any specific rehabilitation intervention.
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