Symptomatic spinal epidural lipomatosis after combined hormonal and steroidal palliative therapy of prostate cancer.

Introduction: Spinal epidural lipomatosis (SLE) is an abnormal accumulation of unencapsulated fat. The association of chronic steroid therapy is described as well as obesity and Cushing's syndrome. SLE has a range of neurological presentations such as back pain, myelopathy, and cauda equina syndrome. Surgical decompression is known to improve symptomatic cases and prevent further deterioration.

Case presentation: An elderly male patient with background history of high-risk metastatic prostate cancer and long-term treatment with steroids and hormonal therapy presented with acute on chronic back pain and neurological symptoms. Spinal cord compression was excluded on the subsequent MRI. However, a spinal epidural lipomatosis causing significant central canal stenosis and compression of the cauda equine was revealed.

Discussion: With the increasing role of MRI in assessing back pain, asymptomatic spinal epidural lipomatosis has been frequently noticed. However, symptomatic presentation after long term combined treatment of steroids and hormonal therapy has not been reported in the literature.