Spinal Epidural Lipomatosis: A Complication of Glucocorticoid Therapy

Abstract

ABSTRACT:A 21-year-old woman receiving prolonged high dosage glucocorticoids developed spinal cord compression due to excessive accumulation of epidural fat. Computerized tomographic scanning confirmed the diagnosis and revealed a peculiar pattern of spinal cord displacement which we believe to be unique to compression by fat. Laminectomy did not afford relief, possibly because of prolonged neural compression or because of compression at a higher spinal level. Although an unusual complication of Cushing's syndrome, epidural lipomatosis should be considered when such a patient develops symptoms of spinal cord or cauda equina compression. RESUME: Une lipomatose 6pidurale a entrain^ une compression mSdullaire chez une patiente de 21 ans, trait6e longtemps avec de fortes doses de glucocorticoides. La tomographic axiale a permis d'6tablir le diagnostic en r6v61ant un defacement d'aspect singulier de la moelle caracte>istique des compressions par tissu adipeux. La laminectomie n'a pas produit les rdsultats escomptSs, soit que la compression datait de trop longtemps, soit qu'etendue elle int£ressait ggalement des segments mddullaires plus rostraux. Complication inusit6e du syndrome de Cushing, la lipomatose Spidurale se doit d'etre retenue face a un tableau de compression de la moelle 6piniere ou de la queue de cheval.

Rapid progression of spinal epidural lipomatosis

“…Clinically, in general, the onset of symptoms is gradual and the condition progresses slowly [6,8]. For patients taking systemic steroid therapy, the time interval between the initiation of steroid use and the onset of neurologic deficit is an average of 19 months [11]. In obese individuals, the average symptom duration is about 20 months [12].…”

Spinal cord compression by epidural lipomatosis in juvenile rheumatoid arthritis

“…The excessive epidural fat may be responsible for neurologic symptoms referable to compression of the spinal cord. Few cases of spinal cord compression due to exogenous steroid-induced epidural lipomatosis have been described in the literature (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”

Severity of presentation is associated with time to recovery in spinal epidural lipomatosis

“…Reviews of fewer patients have presented inconsistent data. One reported mean duration of steroid treatment of 19 months, and another reported 5 to 11 years [13,38]. These large ranges and discrepancies suggest a more complicated underlying pattern.…”