Stemcelldoc's Weblog

September 30, 2011

Epidural Fat and Resultant Narrowing of the Lumbar Canal: A Complication of Epidrual Steroids

Epidural steroid injections are a common treatment for back and extremity pain.  Steroid injections have been associated with complications with include  changes in blood glucose and cortisol levels, infection. apotosis( programmed cellular death), damage to cartilage and the development of  avascular necrosis .   At the Centeno-Schultz Clinic platelet derived growth factors are been used  successfully in the treatment of cervical and lumbar pain.  A  patient who failed traditional epidural steroidshad signficant improvement after Regenexx PL epidural injections.

accumulation of fat around the epidural space can occur as the result of epidural steroid injections.  Narrowing the canal can cause  compression of spinal nerves with resultant pain and restriction in level of activity,

Tok reported a case where a patient developed neurologic symptoms secondary to abnormal epidural fat after a single epidural injection. Sandberg reports symptomatic compression of the neural elements from  excessive epidural fat after repeated epidural steroid injections.

 McCullen reported a similar case   after multiple steroid injections.

Fogel in at literature review and meta analysis demonstrated that exogenous steroid use, obesity and endogenous steroid excess are all associated with symptomatic epidural fat accumulation.

RW is a 45 y/o patient with chronic lower back pain who had received a larger number of lumbar epidural steroid injections from a local pain practice.  He transferred his care to the Centeno-Schultz Clinic.   RW’s lower back pain had escalated in severity.  His most recent lumbar spine MRI was significant for two level narrowing of the spinal canal in part due to a large accumulation of  epidural fat which was not present years prior.  The image below is RW’s most recent MRI.  The blue arrow identities the narrowing of the spinal canal at the L5/S1 level due to multiple steroid injections.

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