Transforaminal epidural steroid injection in the treatment of lumbosacral radicular pain caused by epidural lipomatosis: a case series and review

Abstract

Background: Spinal epidural lipomatosis (SEL) can cause radicular pain due to spinal nerve root impingement. While SEL decompression surgery can provide symptom relief, these patients are often poor surgical candidates due to elevated BMI or immunosuppression. Transforaminal epidural steroid injection (TFESI) has been attempted as an alternative treatment for patients with SEL who are unable to tolerate conservative medical treatment. To date, only two such cases have been reported in the literature.

Objectives: We report three additional cases of radicular pain associated with SEL, review the current literature on this condition, and describe the risks and benefits of using TFESI to treat radicular pain due to SEL.

Methods: We measured changes on the pain visual analogue scale (VAS) and pain disability index (PDI) from presentation to 1-5 weeks after treatment with sequential TFESIs.

Results: Pain VAS scores improved by 50-75% and PDI scores improved 13-44 points.

Conclusions: This case series suggests that TFESI can provide modest short-term symptom relief of lumbosacral radicular pain and improvement in disability caused by SEL. Further study of non-operative management of SEL is warranted, given the high risk associated with surgery in this population.

Keywords: Lipomatosis; epidural injection; radiculopathy.