SPINAL EPIDURAL LIPOMATOSIS AS A COMPLICA TION OF PROLONGED CORTICOSTEROID-THERAPY

Spinal epidural lipomatosis (SEL) is defined as the deposition of loos e fat tissue in the epidural space. Two cases are reported which illus trate the main features of this uncommon disease. Most frequently SEL is revealed by neurologic manifestations such as an acute chronic spin al cord compression. Corticosteroid therapy and obesity are the main f actors able to induce the disease. The common location of the SEL at t he thoracic spine is explained by the physiologic abundance of fat and by the relative narrowness of the spinal canal at this level. An oste oporotic vertebral crush fracture which reduces the diameter of the ca nal frequently reveals the SEL. MRI confirms the diagnosis of SEL and shows the extent in the spinal canal. The treatment of SEL is difficul t. The decrease or the stop of corticosteroid therapy has allowed the recovery in a few cases with chronic neurologic symptoms. The risks of a surgical procedure are important in these patients and the medical or surgical treatment should be discussed taking into account the clin ical symptoms of SEL, its location and extent, and the risks of recurr ence if corticosteroid therapy must go on.