Minimally Invasive Selective Decompression for Sagittal Malalignment due to Steroid-Induced Spinal Epidural...

Area of Science:

• Spine Surgery
• Pediatric Orthopedics
• Medical Case Reports

Background:

• Spinal epidural lipomatosis (SEL) is characterized by excessive adipose tissue accumulation in the epidural space.
• SEL is occasionally linked to exogenous steroid use and is rarely documented in pediatric populations.
• Severe spinal malalignment can result from SEL, impacting patient mobility and neurological function.

Purpose of the Study:

• To report a rare case of steroid-induced SEL in a pediatric patient.
• To describe the management and outcomes of severe sagittal malalignment secondary to SEL in a 15-year-old girl.
• To evaluate the efficacy of surgical decompression in addressing SEL-induced spinal deformities.

Main Methods:

• A 15-year-old female patient presented with severe sagittal malalignment.
• The malalignment was attributed to steroid-induced spinal epidural lipomatosis, associated with immunotherapy for cardiac transplant rejection.
• The patient underwent multilevel spinal decompression without fusion or traditional deformity correction techniques.

Main Results:

• The surgical decompression successfully improved the patient's spinal deformity and associated symptoms.
• Significant improvement in sagittal alignment was observed post-operatively.
• Positive clinical outcomes were maintained at a 2-year follow-up assessment.

Conclusions:

• Nonstructural spinal deformities caused by spinal epidural lipomatosis can be effectively managed with surgical decompression.
• Limited decompression, without extensive fusion, can yield favorable outcomes for SEL-induced spinal deformities.
• This case highlights surgical decompression as a viable treatment option for pediatric SEL when nonoperative management is insufficient.