We aim to investigate the potential association between the administration of Lumbosacral epidural steroid injections (LESIs) and the subsequent onset or progression of Lumbosacral epidural lipomatosis (LEL) in patients devoid of established risk factors for LEL.

We carried out a single-center retrospective study on patients who underwent LESI. We collected demographics including age and gender as well as clinical and radiological characteristics including the type of corticosteroids utilized, the number of LESIs administered, the use of epidural guidance during LESI procedures, and LEL grading. Any patient aged ≥18 years who underwent LESI was included. Exclusion criteria encompassed the absence of magnetic resonance imaging (MRI) data both prior to and following the intervention, presence of endocrinopathies such as Cushing's syndrome or hypothyroidism, diabetes mellitus, and hyperlipidemia.

A total of 3,000 patients were initially screened, 268 patients met the inclusion criteria and were included in the analysis. Mean age was 53.63 years (±12.27), and 50% were male. The predominant treatment administered was methylprednisolone (96.4%). 86% of the patients underwent a single LESI. Fluoroscopy was the guiding modality in 250 (94%) patients. An analysis of LEL grades both before and after LESI revealed variations, with a 7.5% incidence of grade change observed. Logistic regression analysis indicated a trend between male gender and the occurrence of LEL.

Our study emphasizes the relationship between LESIs and the development of LEL and the progression of existing LEL. Further research should investigate this link by conducting larger controlled imaging studies.