Korean J Spine.  2009 Sep;6(3):218-220.

Symptomatic Spinal Epidural Lipomatosis Induced by Repeated Epidural Steroid Injections

• Kim HS
• Han IH
• Lee JH
• Choi BK

Abstract

We present a very rare case of symptomatic spinal epidural lipomatosis(SEL) induced by repeated epidural steroid injections. A 59-year-old woman presented with severe neurogenic claudication and bilateral radiating leg pain aggravated for 1 year. She had undergone epidural triamcinolone injections 19 times for 3 years in a local clinic for chronic low back pain. At first, there had been no symptoms of lumbar stenosis such as leg pain or claudication. During the period of injections, radiating leg pain and claudication appeared newly and were gradually aggravated. Hormonal study and physical examination confirmed iatrogenic Cushing's syndrome. Magnetic resonance imaging(MRI) revealed extensive epidural fat deposition compressing cauda equnina from L3 to S1. Therefore, we concluded that multiple epidural steroid injections caused iatrogenic Cushing's syndrome and SEL. We performed debulking of epidural fat and bilateral neural decompression via left unilateral partial hemilaminectomy at L3-4-5-S1 in order to preserve stability considering preexisting multiple compression fractures. After operation, the patient's neurogenic claudication and radiating pain were completely disappeared.

Keyword

Spinal epidural lipomatosis; Epidural steroid injection

MeSH Terms

Constriction, Pathologic
Cushing Syndrome
Decompression
Female
Fractures, Compression
Humans
Leg
Lipomatosis
Low Back Pain
Magnetic Resonance Spectroscopy
Middle Aged
Physical Examination
Triamcinolone
Triamcinolone