Disclosures: Hamza Khalid, DO: Nothing to disclose

Case Description: A 44-year-old morbidly obese female with a past medical history of sarcoidosis on prednisone therapy since 2012 presented to the rehab clinic for evaluation of lower back pain and urinary incontinence. She reported lower back pain with bilateral radiculopathy since 2015 refractory to NSAIDs and gabapentin. She also admitted to new onset urinary incontinence for the past 6 months. She denied any weakness or saddle anesthesia.

Setting: Tertiary care teaching hospital

Patient: A 44-year-old female with back pain and urinary incontinence.

Assessment/Results: On exam, the patient had significant loss of lumbar lordosis. Range of motion of the lumbar spine was preserved and straight leg raise test was negative bilaterally. Reflexes were 2+ and muscle strength was 5/5 throughout. Sensation was intact to light touch throughout. EMG/NCS revealed no electrodiagnostic evidence of lumbosacral radiculopathy. MRI of the lumbar spine showed lower lumbar disc disease and epidural lipomatosis.

Discussion: Spinal epidural lipomatosis is a rare disorder in which an abnormal amount of fat accumulates on the spinal cord. Risk factors include: morbid obesity, exogenous steroid use, hypothyroidism, and Cushing’s disease. MRI is the diagnostic imaging of choice which typically shows uniformly hyper-intense fat collection in the epidural space, epidural fat thickness greater than 7 mm, and/or circumferential compression of the thecal sac known as the pathognomonic “Y-sign."

Conclusion: Treatment of spinal epidural lipomatosis depends upon the severity of the symptoms. Conservative treatment including weight loss, hormonal treatment, and weaning of exogenous steroids is recommended for those without neurological deficits. Surgical intervention is indicated in patients with severe neurological deficits with decompressive laminectomy and resection of epidural adipose tissue being the procedures of choice. Most patients undergo full neurologic recovery after surgical intervention. Clinicians should be aware of spinal epidural lipomatosis as a differential in patients presenting with atypical back pain with radicular symptoms and neurologic deficits.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spinal-epidural-lipomatosis-due-to-chronic-prednisone-use-in-sarcoidosis-a-case-report/