Spinal epidural lipomatosis as a complication of prolonged corticosteroid therapy

We present the case of a 42-year-old man who complained of low back pain radiating into the posterior aspect of both thighs. There were no neurological deficits, while general medical examination revealed a Cushing's syndrome due to corticosteroid therapy for rheumatic polyarthritis. Myelography showed irregular and circumferential narrowing of the dural sac from L-3 to S-1 caused by abundant epidural fat as demonstrated by MRI. Surgical decompression produced immediate relief of symptoms. The literature of epidural spinal lipomatosis is reviewed and therapeutic considerations are discussed.