Complete radiologic and clinical reversal of lumbar spinal epidural lipomatosis via GLP-1 agonist

Spinal epidural lipomatosis (SEL) is a rare cause of lumbar canal stenosis, typically linked to obesity or corticosteroid use. Severe cases often require decompression. We report a 48-year-old man with chronic low back pain and morbid obesity (153 kg) who presented with extensive SEL and critical stenosis. Previous conservative therapies failed. A non-surgical strategy using GLP-1-induced weight loss (semaglutide) and medical cannabis for pain control was initiated. Over a follow-up of one year, his weight dropped to 93.8 kg, with major improvement in pain and mobility. MRI demonstrated near-complete regression of epidural fat and resolution of stenosis, avoiding surgery. The patient remained neurologically intact. This appears to be the first documented case of SEL reversal achieved through medical weight loss alone. The findings highlight GLP-1 agonists as a potential therapeutic option in obesity-related spinal disorders and support cannabis as part of non-opioid pain management.