University of Wisconsin–Madison Medical College of Wisconsin

Worsening Epidural Lipomatosis Leading to Foot Drop Following an Epidural Steroid Injection: A Case Report

Ragav Sharma, DO; Sahitya Hari, DO; Hariharan Shankar, MBBS

WMJ. 2025;124(2):184-186

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ABSTRACT

Introduction: Epidural lipomatosis is a relatively rare condition resulting in the accumulation of unencapsulated fatty tissue within the epidural space. Steroids, either exogenous or endogenous, have been reported as a cause for this accumulation. The diagnosis is confirmed by computed tomography or magnetic resonance imaging. Symptomatic epidural lipomatosis has been reported to present with radiculopathy, myelopathy, claudication, cauda equina syndrome, or paraplegia. It is usually managed conservatively, including weight loss and avoidance of steroids.

Case Presentation: We report the case of a patient with sarcoidosis on oral prednisone who was referred for low back and leg pain of multifactorial origin. After addressing his low back pain, a fluoroscopically guided lumbar epidural steroid injection was performed for his neurogenic claudication. This provided 3 months of complete pain relief. But the patient also developed unilateral foot drop, possibly secondary to worsening epidural lipomatosis.

Conclusions: Epidural lipomatosis may result in complications that include neurological deficits. Although various disease states may cause it, prudence is advised in the use of exogenous steroids.


Author Affiliations: Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin (Sharma); Department of Anesthesiology, MCW, Milwaukee, Wisconsin (Hari, Shankar).
Corresponding Author: Hariharan Shankar, MBBS, 5000 W National Ave, Milwaukee, WI 53295; phone 414.384.2000 ext. 42104; email hshankar@mcw.edu; ORCID ID: 0000-0002-1567-3887
Financial Disclosures: None declared.
Funding/Support: None declared.
Acknowledgments: The authors obtained written patient consent and Health Insurance Portability and Accountability Act (HIPAA) authorization to publish this report. This was presented as a poster at the Midwest Anesthesia Residents conference and American society of Regional Anesthesia and Pain Medicine 2022 by Saagar Sheth, DO, resident, Medical College of Wisconsin. The authors would like to thank Veronica Carranza, MD, Clement J, Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, for help in image acquisition.
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