Symptomatic spinal epidural lipomatosis induced by a long-term steroid treatment. Review of the literature and report of two additional cases.

Spinal epidural lipomatosis associated with Cushing's syndrome is an uncommon complication (11 reported cases). Two additional symptomatic cases with neurologic deficit are described. Steroid treatment was systemic in the first case and local with epidural injections in the second. The second case is unique because no similar observations have yet been reported. In most cases, a preoperative computed tomographic scan establishes the diagnosis by demonstrating dural compression by an adipose mass. Myelography is far less specific. In some cases, the exact diagnosis is made at the time of surgery. The treatment is primarily surgical, with laminectomy over the length of the compression and the removal of the compressing fat. Neurologic recovery is dependent on two factors: the level of the compression and the adequacy of decompression.