Symptomatic spinal epidural lipomatosis as a complication of steroid immunosuppression in cardiac transplant patients

✓ Patients with Cushing's syndrome may develop spinal epidural lipomatosis, an abnormal accumulation of fat in the spinal epidural space. This accumulation of fat may cause compression of the spinal cord or cauda equina with resulting neurological deficit. Two cases of symptomatic spinal lipomatosis are reported in cardiac transplant patients receiving chronic corticosteroid treatment. The literature is reviewed, and diagnostic and therapeutic considerations are discussed.

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Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management

Global Spine Journal ◽

10.1177/2192568218793617 ◽

2018 ◽

Vol 9 (6) ◽

pp. 658-665 ◽

Cited By ~ 4

Author(s):

Keonhee Kim ◽

Joseph Mendelis ◽

Woojin Cho

Keyword(s):

Cauda Equina ◽

Specific Treatment ◽

Postoperative Mortality ◽

Surgical Decompression ◽

Treatment Modalities ◽

Spinal Epidural Lipomatosis ◽

Epidural Lipomatosis ◽

Current Trends ◽

Institutional Review ◽

Spinal Epidural

Study Design:Narrative review of available literature.Objective:To summarize current trends in pathogenesis and management of spinal epidural lipomatosis (SEL) and suggest areas where more research would be of benefit.Methods:The available literature relevant to SEL was reviewed. PubMed, Medline, OVID, EMBASE, Cochrane, and Google Scholar were used to review the literature. Institutional review board approval is not applicable for this study.Results:This article clearly summarizes current trends in the pathogenesis and management of SEL.Conclusions:Possible etiologies of SEL include exogenous steroid use, endogenous steroid hormonal disease, obesity, surgery induced, and idiopathic disease. Comorbidities such as acquired immunodeficiency syndrome and Scheuermann’s disease have also been implicated in the pathogenesis of SEL. Steroid-induced SEL seems to have a proclivity for the thoracic region of the spine and has a higher incidence of paraplegia when compared with other forms. Several treatment modalities exist for SEL and are dictated by the underlying cause of the disorder. These include weight reduction, cessation of steroid medications, treatment of underlying endocrine abnormalities, and surgical decompression. Conservative treatments generally aim to decrease the thickness of adipose tissue in the epidural space, but the majority of patients tend to undergo surgical decompression to relieve neurologic symptoms. Surgical decompression provides a statistically significant reduction in symptoms, but postoperative mortality is high, influenced primarily by the patient’s preoperative comorbidities. Physicians should consider the underlying cause of SEL in a given patient before pursuing specific treatment modalities, but alarm symptoms, such as the development of acute cauda equina syndrome, should likely be treated with urgent surgical decompression.

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Idiopathic Spinal Epidural Lipomatosis: Unusual Presentation and Difficult Management

Case Reports in Pediatrics ◽

10.1155/2021/4562312 ◽

2021 ◽

Vol 2021 ◽

pp. 1-2

Author(s):

Ouidad Louachama ◽

Noureddine Rada ◽

Ghizlane Draiss ◽

Mohamed Bouskraoui

Keyword(s):

Corticosteroid Therapy ◽

Epidural Space ◽

Unusual Presentation ◽

Spinal Epidural Lipomatosis ◽

Epidural Lipomatosis ◽

Abnormal Accumulation ◽

Spinal Epidural ◽

Possible Cause

Epidural lipomatosis (EL) is a pathology characterized by abnormal accumulation of unencapsulated fat in the epidural space. Although rare, it is a possible cause of lumbosciatica or narrow lumbar canal in adults. It is often associated with favorable factors such as prolonged corticosteroid therapy or obesity. We report an observation of an 18-month-old child who presented with walking delay without other abnormalities, and the radiological exploration confirmed the lumbar epidural lipomatosis. The management was mainly symptomatic, based on motor physiotherapy with additional management in neurosurgery. Various etiologies can cause this disease, remain rare in pediatrics, and the idiopathic form is predominant in children.

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