Normally a thin layer of fatty tissue around the thecal sac and the nerve roots facilitates the motion of these structures in the spinal canal. However in some cases this layer can thicken and exercise pressure upon the thecal sac and/or the nerve roots. Lipomas may spread over several segments and thus lead to symptoms similar to spinal stenosis or disc herniation. Spinal lipomatosis can only be diagnosed by MRI. In the case of such symptoms, an operation, using a minimally invasive open approach is indicated and results are usually excellent.