Presented at the 2013 AAPM Annual Meeting « Back

Atypical Presentation of Acute Low Back Pain in Sarcoidosis: Spinal Epidural Lipomatosis

Duane E. Griffin, OPA MPH MPAS, duane.griffin@amedd.army.mil¹, Monika A. Krzyzek, DO², Brandon J. Goff, DO³, Robert H. Overbaugh, MD¹, Kevin Guthmiller, MD¹, Karl A. Lautenschlager, MD², (1) Brooke Army Medical Center, Fort Sam Houston, Texas, (2) San Antonio Military Medical Center, San Antonio, Texas, (3) San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas

Introduction/Statement of the Problem: We present a unique case of a 48 year old male who came in with acute onset of thoracolumbar pain with radiation down both lower extremities without weakness. This gentleman was diagnosed with pulmonary sarcoidosis in 2010 and immediately started on prednisone therapy. The patient began experiencing thoracolumbar pain July 2012; however, since there was a long standing history of cervical pain secondary to degenerative joint disease, it was assumed that he had subsequently developed thoracolumbar spondolyosis. Materials and Methods: Standard thoracolumbar radiographs were obtained which demonstrated multilevel degenerative spondolysis of the thoracolumbar spine, but did not explain the patient complaint of relentless and diffuse back pain with pain with radiation into both legs. Thus, magnetic resonsonate imaging without contrast was ordered of the thoracolumbar spine which showed diffuse epidural llipomatosis throughout the lumbar spine contributing to multiple levels of moderate to severe spinal canal stenosis and severe foraminal stenosis. Results: The patient’s symptoms were from a combination of spondolyosis and epidural lipomatosis throughout the lumbar spine which caused severe central and foraminal stenosis with radiculopathy. Conclusions: Spinal epidural lipomatosis is a rare disorder that is commonly associated with long-term use of corticosteroids and can present with a progressive neurological deficits such as pain, sensory changes, and occasionally incontinence of bowel and bladder. Initial treatment is usually conservative either weaning or discontinuation use exogenous steriods and weight loss. Decompressive laminectomy with resection of the epidural fat tissue is useful for improving neurological symptoms.

Funding: None