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A 63 year old man with diabetes who had a body mass index of 39 (normal range 20-25) presented to his general practitioner with lower back pain and clinical features suggesting spinal stenosis. He was referred for magnetic resonance imaging of the spine. The axial T1 weighted image showed narrowing of the lumbar spinal canal caused by excessive fat deposition in the epidural space, crowding the lumbar nerve roots, in keeping with spinal epidural lipomatosis. Most reported cases of spinal epidural lipomatosis are associated with long term use of exogenous corticosteroids. Another association, as in this case, is obesity. Cushing's disease, Cushing's syndrome, hypothyroidism, pituitary prolactinoma, and idiopathic causes should also be considered.considered.