Progressive myelopathy associated with spinal epidural lipomatosis in three non-obese patients with type 1 diabetes mellitus

Is there an association between lumbosacral epidural lipomatosis and lumbosacral epidural steroid injections? A comprehensive narrative literature review

“…It is apparent that there are coexisting, interwoven, collective and likely compounding factors that predispose to SEL. This has been a focus of recent studies and metabolic syndrome is postulated to be the connecting link [ 1 , 5 , 18 , [22] , [23] , [24] , [25] , [26] , [27] ]. Based on the National Health and Nutritional Examination Survey (NHANES) data, it has been estimated that at least 68 million U.S. adults meet the criteria for the metabolic syndrome and the trend only seems to be increasing [52] .…”

“…There is inconsistency in the usage of the idiopathic categorization, however, this generally refers to the development of SEL in non-obese patients without a known predisposing underlying risk factor or disorder [ 3 , 8 ]. Although the multifactorial pathophysiology of epidural adipose tissue hyperplasia in SEL is not fully understood, recent investigations have focused on the association between the metabolic syndrome and SEL [ 5 , 18 , [22] , [23] , [24] , [25] , [26] , [27] ].…”

“…3,8 Although the multifactorial pathophysiology of epidural adipose tissue hyperplasia in SEL is not fully understood, recent investigations have focused on the association between the metabolic syndrome and SEL. 5,18,[22][23][24][25][26][27] Most of the literature demonstrating an association between SEL and long-term exogenous steroid use revolves around systemic utilization for purposes such as the prevention or treatment of post-organ transplantation rejection, various autoimmune diseases, chronic obstructive pulmonary disease (COPD), nephritic syndromes, asthma, radiation pneumonitis, in the setting of cancer-related care and even anabolic steroid (without glucocorticoid) use. [1][2][3][6][7][8]12,24 Pediatric SEL cases have also been reported.…”

Rare Case of Spinal Neurosarcoidosis with Concomitant Epidural Lipomatosis

“…This would be more challenging in a case such as ours in which there is concomitant pathology such as epidural lipomatosis that is also relatively rare and might explain this myelitis. Whether the resolution in the lesion was related to decrease in venous congestion after surgical repair of epidural lipomatosis only or is a combination of both responses to mycophenolate mofetil and surgery remains a possibility, given similar reported cases of epidural lipomatosis that improve after surgery [ 6 ].…”

Surgical management of thoracic myelopathy from long-segment epidural lipomatosis with skip hemilaminotomies: illustrative case

“…However, other manifestations have included radiculopathy, myelopathy, neurogenic claudication, dysesthetic pain, weakness in the limbs, and even cauda equina syndrome. 12 Reported etiologies of SEL have included exogenous steroid use, 13 endogenous steroid hormonal disease, 11,14 obesity, 15,16 prior surgery, 10,17 and idiopathic disease. 18 In addition, comorbidities such as hyperlipidemia, 19 acquired immunodeficiency syndrome, 20 Scheuermann kyphosis (SK), 21 and Paget's disease of bone 22 have been associated with SEL.…”