Symptomatic spinal epidural lipomatosis after combined hormonal and steroidal palliative therapy of prostate cancer

Abstract

With the increasing role of MRI in assessing back pain, asymptomatic spinal epidural lipomatosis has been frequently noticed. However, symptomatic presentation after long term combined treatment of steroids and hormonal therapy has not been reported in the literature.

Chronic Steroid Use Causing Spinal Epidural Lipomatosis

“…It is most likely related to dural adipose tissue enlargement, which can constrict the spinal canal and induce cord compression if severe. This is most commonly seen in patients on exogenous steroid medication, although this can also occur in those with endocrinopathies, endogenous corticosteroid overproduction, obesity, or idiopathic disease [ 3 ]. SEL is an uncommon but well-documented side effect of long-term corticosteroid treatment, which was originally reported in 1975 in a young patient who received corticosteroids following a kidney transplant [ 4 ].…”

“…Incontinence of the bowel and bladder is uncommon. Further disease development is anticipated to have an equal impact on the thoracic and lumbar spinal areas [ 3 ].…”

“…MRI is the diagnostic modality of choice due to its superior and selective ability to discriminate fat content during imaging. T1-weighted pictures of adipose tissue are generally hyperintense, but water-filled portions of tissues can present similarly [ 3 ]. Circumferential compression of the thecal sac, also known as the “Y-sing,” is pathognomonic in lumbar axial imaging.…”

“…Treatment options range from conservative therapy to spinal surgical surgery, depending on the severity of neurological impairments. Two of the more conservative alternatives include weaning off steroid therapy and losing weight [ 3 ]. Some patients, however, are on steroid medication for chronic diseases and may not be able to stop taking it.…”

“…This operation relieves the compression by removing the lamina portion of the vertebrae at the level of epidural lipomatosis. After surgery, most patients achieve improvement or eradication of their neurological symptoms [ 3 ].…”