Background/Purpose: Steroid-induced epidural lipomatosis (SEL) is a rare phenomenon causing neuronal compression from adipose tissue deposition in the epidural space. We analyzed the available literature in a systematic review to determine the patient demographics, underlying disease, oral steroid doses, intervention, and outcomes of SEL.

Methods: A comprehensive database search was performed for articles reporting spinal epidural lipomatosis from oral steroid therapy from conception to May 26, 2021. Full-text articles in English language meeting our predefined criteria were analyzed for review (Figure 1).

Results: We included 36 articles for our systematic review including data of 45 patients. The mean age of patients presenting with SEL was 50.1 (27-75) years with male predominance (80.0%). The most common presenting symptom was paraparesis 82.0% (n= 35), followed by back pain 44.4% (n=25). One-third (31.1%) of the patient population had an inflammatory rheumatological indication for chronic steroid therapy. Rheumatoid arthritis was the most common inflammatory disorder in these (57%). The median oral steroid dose was 20.0 (9.75-45.8) mg/day with a median duration of 24.0 (12.0-57.0) months before the diagnosis of SEL. Thoracic spine was affected in 55.8% (n=24), lumbar spine in 34.8% (n=15) and both in 9.3% Laminectomy was performed in 73.3% (n=33) of cases. Case outcomes were variable, however the majority reported recovery to ambulation (65.2%).

Conclusion: SEL should be considered as a possible etiology for lower limb weakness in patients on chronic oral steroid therapy. Our review highlights this rare association that may further increase the morbidity in patients with underlying rheumatological diseases.

Figure 1. PRISMA FLOW DIAGRAM

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-characteristics-of-steroid-induced-spinal-epidural-lipomatosis-a-systematic-review/