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Epidural Lipomatosis Secondary To Transforaminal Epidural Steroid Injections 2013

Category General Spine Charles P. Pluto III., MD, PhD
Gamaliel Lorenzo, MD
Purpose To report a case of a 65 year-old man who develops severe epidural lipomatosis from L3 through S1 after a series of four bilateral transforaminal steroid injections during an 8 month period of time. Materials & Methods Serial lumbar spine MR imaging studies were reviewed.  Clinical documents were also reviewed for specific dates and dosages of the steroid injections. Results A 65 year old veteran presented to the spine intervention clinic after having failed 6 weeks of conservative therapy for L5 radicular pain. Lumbar spine MR was performed demonstrating mild degenerative disk disease isolated to L5/S1 but not resulting in significant spinal canal or neural foraminal stenosis. Bilateral L5 transforminal epidural injections were recommended and administered without complications. The patient returned with worsening pain which now more resembled claudication.  A repeat lumbar spine MR demonstrated a significant interval increase in the amount of ventral and dorsal epidural fat from the L3 to S1 level, resulting in severe narrowing of the thecal sac. Cerebrospinal fluid was no longer seen in the thecal sac distal to the mid L5 level. Conclusion Chronic low back pain is a common condition resulting in a significant burden on the health care system. While some patients respond to conservative approaches, many non-responders gain significant relief and functional improvement with epidural or transforaminal steroid injections. Spinal epidural lipomatosis can cause symptomatic compression of the spinal cord and nerve roots and has been well documented in patients with Cushing’s syndrome and in those on chronic systemic steroids. Epidural steroid injection is a less common cause of epidural lipomatosis. This is, to our knowledge, the first reported case of epidural lipomatosis resulting specifically from transforaminal approach steroid injections. References McCullen GM, Spurling GR, Webster JS. Epidural lipomatosis complicating lumbar steroid injections. J Spinal Disord. 1999 Dec;12(6):526-9. PubMed PMID: 10598996. Danielson KD, Harrast MA. Focal spinal epidural lipomatosis after a single epidural steroid injection. PM R. 2011 Jun;3(6):590-3. PubMed PMID: 21665172. Tok CH, Kaur S, Gangi A. Symptomatic spinal epidural lipomatosis after a single local epidural steroid injection. Cardiovasc Intervent Radiol. 2011 Feb;34 Suppl 2:S250-5. PubMed PMID: 20859631. Sandberg DI, Lavyne MH. Symptomatic spinal epidural lipomatosis after local epidural corticosteroid injections: case report. Neurosurgery. 1999 Jul;45(1):162-5. PubMed PMID: 10414580. No disclosures.