Epidural Lipomatosis Complicating Lumbar Steroid Injections

McCullen, Geoffrey M.; Spurling, Gregory R.; Webster, John S.

doi:10.1097/00002517-199912000-00013

Cited by 54 publications

(70 citation statements)

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“…reported first a SEL after lumbar epidural steroid injection. Then, four cases associated with epidural steroid injection have been reported [14][15][16][17]. We summarized five reported cases in Table 1.…”

Section: Discussionmentioning

confidence: 99%

Rapid progression of spinal epidural lipomatosis

et al. 2011

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Spinal epidural lipomatosis (SEL) is a rare but well-recognized condition. In general, the onset of its symptoms is insidious and the disease progresses slowly. We report two cases of rapid progression of SEL with no history of steroid intake in non-obese individuals after epidural steroid injection. These SEL patients developed neurologic symptoms after less than 5 months; these symptoms were confirmed to be due to SEL by serial MR images. After the debulking of the epidural fat, their symptoms improved.

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Section: Discussionmentioning

confidence: 99%

Rapid progression of spinal epidural lipomatosis

et al. 2011

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“…8) Local SAT injections: Corticosteroid injections have been suggested as treatment for lipomatosis such as MSL SAT [106] but there are a number of cases demonstrating the development of lipomatosis after steroid use [107,108] . Local injection with thyroxine [107] , enoxaparin [109] , deoxycholate [110] , and phosphatidylcholine [78] have also been proposed for treatment of lipomas but the latter require multiple injections and use of thyroxine injections in the presence of autonomic dysfunction would be dangerous.…”

Section: Msl Treatment Recommendationsmentioning

confidence: 99%

“…Local injection with thyroxine [107] , enoxaparin [109] , deoxycholate [110] , and phosphatidylcholine [78] have also been proposed for treatment of lipomas but the latter require multiple injections and use of thyroxine injections in the presence of autonomic dysfunction would be dangerous. In addition, the extent of the SAT in MSL does not allow for single site injections, limiting these treatments to lipomas.…”

Section: Msl Treatment Recommendationsmentioning

confidence: 99%

Rare adipose disorders (RADs) masquerading as obesity

2012

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Rare adipose disorders (RADs) including multiple symmetric lipomatosis (MSL), lipedema and Dercum's disease (DD) may be misdiagnosed as obesity. Lifestyle changes, such as reduced caloric intake and increased physical activity are standard care for obesity. Although lifestyle changes and bariatric surgery work effectively for the obesity component of RADs, these treatments do not routinely reduce the abnormal subcutaneous adipose tissue (SAT) of RADs. RAD SAT likely results from the growth of a brown stem cell population with secondary lymphatic dysfunction in MSL, or by primary vascular and lymphatic dysfunction in lipedema and DD. People with RADs do not lose SAT from caloric limitation and increased energy expenditure alone. In order to improve recognition of RADs apart from obesity, the diagnostic criteria, histology and pathophysiology of RADs are presented and contrasted to familial partial lipodystrophies, acquired partial lipodystrophies and obesity with which they may be confused. Treatment recommendations focus on evidencebased data and include lymphatic decongestive therapy, medications and supplements that support loss of RAD SAT. Associated RAD conditions including depression, anxiety and pain will improve as healthcare providers learn to identify and adopt alternative treatment regimens for the abnormal SAT component of RADs. Effective dietary and exercise regimens are needed in RAD populations to improve quality of life and construct advanced treatment regimens for future generations.

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“…The bodily distribution of fat is not reported in the majority of cases described in the literature, and it is therefore difficult to associate idiopathic epidural lipomatosis with a particular obesity phenotype (central adiposity). It is nevertheless possible that, given that it is found in Cushing's syndrome and in long-term treatment with glucocorticoids [8], central fat distribution is a common characteristic in all cases of epidural lipomatosis. Although not all the factors determining the localization of adipose tissue (abdominal vs. subcutaneous) are known, insulin appears to play a key role.…”

Section: Discussionmentioning

confidence: 99%

“…In most cases such lipomatosis is related to local [8] or systemic [4,6,11] administration of glucocorticoids, and a few cases have been reported associated with Cushing's syndrome [9,12]. Idiopathic forms of the disease seem to occur in obese patients but their physiopathology remains unclear.…”

Section: Introductionmentioning

confidence: 99%