We present a patient with
prednisone-induced spinal epidural
lipomatosis (SEL) and relatively acute neurologic deterioration followed by rapid recovery after
surgical decompression. SEL is a
rare disease characterized by
hypertrophy of epidural fat, most commonly associated with exogenous
steroid use. To our knowledge, an analysis of the dynamics of
steroid dose related to time to onset has never been performed, or of patient presentation features with respect to patient outcome. We retrospectively reviewed the literature for English language series and case reports of SEL associated with
prednisone use from 1975-2013. Data were compiled for 41 patients regarding the prescribed dose of
prednisone and length of treatment, as well as the severity of symptoms on the Ranawat scale, time to onset, time to recovery, and degree of recovery of neurological symptoms. Fisher's exact test and analysis of variance were used for comparing proportions, and p values <0.05 were considered statistically significant. We found that the mean cumulative dose of
prednisone trended towards an association with a lack of recovery (p=0.06) and may be related to rate of recovery. Prescribed
prednisone dose varied inversely with the time before onset of neurological symptoms, but failed to reach statistical significance. Higher severity of presenting symptoms on the Ranawat scale were found to be associated with a higher likelihood of delayed recovery (p=0.035). Patients with symptoms lower on the Ranawat scale more frequently experienced complete neurologic recovery, though this did not reach significance. The acuity of neurological deterioration was not related to the time to recovery or ultimate degree of recovery. Severity of presentation on the Ranawat scale is associated with rate of recovery and may be related to degree of recovery in SEL patients. Cumulative dose of
prednisone may be related to degree and rate of recovery. Prescribed dose of
prednisone may be related to time to onset of neurological symptoms. Acuity of neurological deterioration is not related to rate or degree of recovery.