腰椎分離すべり症にepidural lipomatosisを合併したCushing病の1例

Lumbosacral Spondylolytic Spondylolisthesis Associated with Epidural Lipomatosis in a Patient with Primary Cushing's Disease. Case Report

　抄録：腰椎分離すべり症にepidural lipomatosis（EL）を合併したCushing病の1例を経験した．症例は52歳，女性．主訴は両大腿～下腿後面の疼痛と間歇跛行．7年前よりCushing病を指摘されていた．単純X線上L5にgrade 3の分離すべりを認め，MRIではL4～S1のレベルで，硬膜外脂肪により硬膜管は背側より圧迫されていた．脊髄造影ではL5/S1レベルで不完全ブロックを認めた．L5-S1経仙椎的椎体間固定術および後側方固定術を施行し，間歇跛行は消失した．Cushing病（内因性Cushing症候群）にELが合併した報告例は少なく，さらに分離すべり症とELの合併については，自験例が2例目の報告となる．Cushing症候群の患者が神経症状を呈した場合，ELの発生の可能性も考慮する必要がある．

　We describe the case of a patient with primary Cushing's disease who had both a lumbosacral spondylolytic spondylolisthesis and epidural lipomatosis. This 52-year-old woman with 7-year-history of primary Cushing's disease complained bilateral leg pain accompanied by intermitted claudication. Radiographs showed the fifth lumbar spondylolytic spondylolisthesis (grade 3). Magnetic resonance image demonstrated compression of the thecal sac from L4 to S1 secondary to epidural fat. Myelography revealed an imcomplete block at the L5-S1 level. The patient underwent L5-S1 transbody fusion and postero-lateral fusion. Postoperatively the patient's symptoms improved. Epidural lipomatosis in a patient with primary Cushing's disease has rarely been reported, and as far as we know, this is the second report of epidural lipomatosis with lumbosacral spondylolytic spondylolisthesis. When a patient with Cushing's disease shows neurological examination, we must take into consideration the possibility of epidural lipomatosis.