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Area of Science:

  • Neurology
  • Endocrinology
  • Neurosurgery

Background:

  • Chronic corticosteroid therapy is associated with aberrant epidural fat deposition.
  • Spinal epidural lipomatosis (SEL) is a rare consequence of prolonged steroid use.
  • Polymyalgia rheumatica and adrenal insufficiency are conditions requiring long-term steroid management.

Observation:

  • A 79-year-old female with a history of polymyalgia rheumatica and adrenal insufficiency presented with severe lumbosacral pain.
  • The patient had a history of long-term steroid use, including stress doses for adrenal insufficiency.
  • Magnetic resonance imaging revealed spinal epidural lipomatosis, foraminal stenosis, and spinal canal stenosis.

Findings:

  • The patient was diagnosed with spinal epidural lipomatosis secondary to chronic steroid use.
  • Imaging confirmed significant spinal canal and foraminal stenosis contributing to her pain.
  • Surgical decompression via laminectomy provided a successful outcome.

Implications:

  • This case underscores the importance of recognizing SEL as a potential complication of chronic steroid therapy.
  • Early diagnosis through imaging is crucial for effective management of steroid-induced epidural lipomatosis.
  • Surgical intervention, such as laminectomy, can effectively alleviate pain and neurological deficits associated with SEL and stenosis.