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Tardivo V, Scudieri C, Bruzzo M, Lupidi F. Acute neurologic decline in a patient with spinal stenosis: blame it on the epidural fat. Br J Neurosurg 2024; 38:765-770. [PMID: 34319197 DOI: 10.1080/02688697.2021.1958149] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/15/2021] [Accepted: 06/30/2021] [Indexed: 10/25/2022]
Abstract
Spinal epidural lipomatosis [SEL] is defined as an excessive accumulation of extradural normal adipose tissue. This condition may be idiopathic or acquired. Surgical decompression is considered the gold standard treatment in patients presenting with progressive neurologic deficit. We report a case of a 69-year-old male patient presented with neurogenic claudication and lower left limb radiculopathy. The magnetic resonance imaging (MRI) revealed a L5-S1 epidural compression sustained by a large epidural plaque whose signal was consistent with adipose tissue. A conservative approach, including weight loss attempt, revealed unsuccessful and the patient presented some months after the diagnosis at the emergency department with acute onset bilateral drop foot, more severe on the right side and urinary disturbances. Microsurgical decompression via L5 laminectomy and partial L4 laminectomy and fatty plaque debulking was performed. The post operative course was uneventful and at the two months post operative follow up the patient reported a significative improvement of the pre operative neurological signs and symptoms and of pain control. SEL deserves attention as an identifiable cause of radiculopathies, typically attributed to spinal stenosis, with a higher incidence than previously reported. Moreover cases of acute onset of cauda equina like syndrome were reported in patent affected by SEL, probably related to a local venous engorgement with stasis and edema. Therefore it should be considered as a possible diagnosis not only in patients complaining of stenosis-type symptoms but also in cases of acute neurological decline with cauda equina like syndrome, especially when provided with a "benign" imaging reading.
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Affiliation(s)
- Valentina Tardivo
- Neurosurgery Unit San Carlo Borromeo Hospital, Milan, Italy
- Neurosurgery Unit, EO Ospedali Galliera, Genova, Italy
| | - Claudia Scudieri
- Neurosurgery Unit, EO Ospedali Galliera, Genova, Italy
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Mattia Bruzzo
- Neurosurgery Unit San Carlo Borromeo Hospital, Milan, Italy
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Alshoubi A. Postpartum Spinal Epidural Lipomatosis With Epidural Venous Engorgement. Cureus 2023; 15:e45184. [PMID: 37842371 PMCID: PMC10575794 DOI: 10.7759/cureus.45184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Spinal epidural lipomatosis (SEL) refers to a condition characterized by the abnormal growth of fatty tissue within the vertebral canal, situated outside the spinal canal itself. This expansion of fat can result in symptoms such as back pain and radiculopathy. The majority of cases remain without noticeable symptoms. However, when SEL does cause symptoms, it is frequently linked to using external steroids. The contributing factors to SEL include obesity and Cushing's syndrome. The presentation of SEL can mimic other spinal disorders such as epidural hematoma, spinal stenosis, and degenerative joint disease. Patients might present with gradually progressing and long-standing complaints of back pain, muscle weakness, numbness, loss of bladder or bowel control, lack of coordination, abnormal reflexes, and, in rare instances, paralysis. We are reporting a case involving a 34-year-old female with obesity, who experienced sudden weakness in her left lower extremity shortly after a recent uncomplicated vaginal delivery using epidural analgesia. A magnetic resonance imaging (MRI) of her thoracic (T) and lumbar spine revealed spinal cord compression secondary to extensive posterior epidural lipomatosis associated with epidural venous engorgement. The patient underwent an immediate laminectomy procedure at the T3, T5, T7, and T9 levels to alleviate the compression. Postoperatively, she underwent a course of physiotherapy and gradually regained her normal muscle strength. She was discharged in stable condition on the sixth day after the surgery.
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Affiliation(s)
- Abdalhai Alshoubi
- Anesthesiology and Critical Care, University of Illinois College of Medicine Peoria, Peoria, USA
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Rigsby RK, Barnes S, Sabaté J, Oyoyo U, Chowdhury S, Peters EM. Correlation of spinal epidural fat volume with body mass index: a longitudinal study. Clin Imaging 2023; 98:61-66. [PMID: 37004496 DOI: 10.1016/j.clinimag.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/05/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Spinal epidural lipomatosis is abnormal accumulation of normal fat in the epidural space with weight loss suggested as first-line therapy in select symptomatic patients. However, moderate to large longitudinal studies establishing concordant changes between body mass index and epidural fat are lacking. The purpose of this study was to longitudinally assess this relationship. METHODS We performed an ancillary study of the Habitual Diet and Avocado Trial. Baseline and six-month abdominal MRIs were analyzed for 98 overweight or obese but otherwise healthy subjects. Dorsal epidural fat volumes in the lumbar spine were measured and correlated with changes in body mass index, changes in visceral fat volume, and demographic information. RESULTS There was a linear relationship between body mass index changes and epidural fat volume changes with a one-point change in body mass index corresponding to a 45 mm3 change in dorsal epidural fat volume (p < 0.001, 95% CI 31.87 to 76.77) as well as between visceral fat volume changes and epidural fat volume changes (regression coefficient 0.51, p < 0.001, 95% CI 0.22 to 0.47). Age was inversely related with subjects older than 45.7 years tending to lose epidural fat (regression coefficient -0.22, p = 0.025, 95% CI -10.43 to -0.72). CONCLUSION Changes in spinal dorsal epidural fat volume parallel changes in body mass index and visceral fat, supporting weight loss as initial treatment for uncomplicated obesity-associated spinal epidural lipomatosis.
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Lim MJR, Zheng Y, Babla Singbal S, Makmur A, Yeo TT, Kumar N. Clinical and radiological characteristics of spinal epidural lipomatosis: A retrospective review of 90 consecutive patients. J Clin Orthop Trauma 2022; 32:101988. [PMID: 36035782 PMCID: PMC9413947 DOI: 10.1016/j.jcot.2022.101988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/07/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background The epidemiology and clinical characteristics of spinal epidural lipomatosis (SEL) have been well-reported in the literature. However, few studies investigated the concomitant spinal pathologies that were present in patients with SEL. Therefore, we aimed to summarize the clinical and radiological characteristics of patients with SEL diagnosed on spinal imaging. Methods Patients who were diagnosed with SEL on magnetic resonance imaging from January 2018 to October 2020 at our institution were included in the study. Clinical data was collected using a standardized data collection form. SEL was graded using a modified version of the Borré grading system. Factors associated with moderate or severe SEL were determined using multiple logistic regression. Results A total of 90 patients were included in the analysis. The mean (±SD) age was 59.3 (±17.1) years, and 62 patients (68.9%) were male. 61 patients (67.8%) had moderate or severe SEL. Most patients were overweight or obese (57 patients, 63.3%). The most common presenting symptoms was back pain (57 patients, 63.3%). SEL was diagnosed incidentally in 42 patients (46.7%). The lumbar spine was the most common site of SEL (35 patients, 38.9%). The most common concomitant spinal pathologies were disc bulge (83 patients, 92.2%) and flavum hypertrophy (60 patients, 66.7%). Moderate or severe SEL was associated with WHO Obesity Class, back pain or radicular leg pain at first presentation, and SEL that was worst at the lumbar or lumbosacral spinal level. Conclusions Moderate or severe SEL were independently associated with WHO Obesity Class, back pain, radicular leg pain, and SEL that was worst at the lumbar or lumbosacral spinal level. Future studies should prospectively evaluate whether weight loss therapy is warranted in patients with SEL.
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Affiliation(s)
| | - Yilong Zheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Salil Babla Singbal
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Health System, Singapore
| | - Tseng Tsai Yeo
- Division of Neurosurgery, National University Health System, Singapore
| | - Naresh Kumar
- Department of Orthopedic Surgery, National University Health System, Singapore
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Alsofyani MA, Alsalmi S, Malaekah H, Alharthi M, Bourghli A, Obeid I, Boissière L. Resolution of Idiopathic Epidural Lipomatosis after Bariatric Surgery: Case Report and Literature Review. Asian J Neurosurg 2021; 16:217-220. [PMID: 34211899 PMCID: PMC8202365 DOI: 10.4103/ajns.ajns_294_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/07/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022] Open
Abstract
Spinal epidural lipomatosis (SEL) is traditionally a rare disorder defined as an abnormal accumulation of unencapsulated epidural fat. SEL can be classified into idiopathic and secondary. We report a 46-year-old obese male with idiopathic epidural lipomatosis with a clinical picture of bilateral L5 and S1 radiculopathy, with an L5 and S1 distribution. Magnetic resonance imaging (MRI) showed epidural lipomatosis at L4, L5, and S1. After 2-year of sleeve gastrectomy, his bilateral sciatic radiculopathy disappeared, and updated MRI showed complete resolution of epidural lipomatosis. We present a case of an unusual epidural lipomatosis, resolved completely by bariatric surgery. This case report set out the effect of metabolic surgery on the local and systemic metabolic process.
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Affiliation(s)
- Mohammad A Alsofyani
- Department of Surgery, College of Medicine and University Hospital, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Sultan Alsalmi
- Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Haifaa Malaekah
- Department of Surgical, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdurrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Majed Alharthi
- Department of Surgical, Security Forces Hospital, Makkah, Kingdom of Saudi Arabia
| | - Anouar Bourghli
- Department of Orthopedic and Spinal Surgery, Kingdom Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim Obeid
- Department of Spine Surgery, Specialist Terrefort Clinic, Bruges, France
| | - Louis Boissière
- Department of Spine Surgery, Specialist Terrefort Clinic, Bruges, France
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Mallard F, Buni M, Nolet PS, Emary P, Taylor JA, Moammer G. Lumbar spinal epidural lipomatosis: A case report and review of the literature. Int J Surg Case Rep 2021; 78:71-75. [PMID: 33310475 PMCID: PMC7736757 DOI: 10.1016/j.ijscr.2020.11.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Lumbar spinal epidural lipomatosis (SEL) is a rare condition defined by an excessive deposition of adipose tissue in the lumbar spinal canal. The objective of this case report is to document a clinical case of SEL presenting within a multidisciplinary spine clinic and to compare our clinical findings and management with the available literature. CASE PRESENTATION A 51-year-old female presented at a spine clinic with low back pain, bilateral leg pain and difficulty walking. Magnetic resonance imaging of the lumbar spine showed evidence of severe central canal stenosis due to extensive epidural lipomatosis. She was initially advised to lose weight and undergo a 3-month course of physiotherapy. However, because of lack of improvement, she was scheduled for and underwent L4-S1 posterior spinal decompression and L4-L5 posterior spinal instrumented fusion. At 12-month follow-up, the patient reported no pain and retained the ability to walk regular distances without experiencing discomfort. DISCUSSION This case report describes the conservative and surgical management of a case of lumbar spinal stenosis due to SEL. The therapeutic approach of patients with this condition is not standardized. As such, a discussion of the literature with respect to the diagnosis, clinical presentation, epidemiology, imaging appearance, risk factors, etiology, and management of SEL is also presented.
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Affiliation(s)
- Fabrice Mallard
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Institut Franco-Européen de Chiropraxie, Toulouse, France.
| | - Manar Buni
- Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Paul S Nolet
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario, Canada; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Peter Emary
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Private Practice, Cambridge, Ontario, Canada; D'Youville College, Department of Chiropractic, Buffalo, New York, USA
| | - John A Taylor
- D'Youville College, Department of Chiropractic, Buffalo, New York, USA
| | - Gemah Moammer
- McMaster University, Grand River Hospital, Kitchener, Ontario, Canada; Spine Surgery, Grand River Hospital Corporation, Kitchener Waterloo Site, Ontario, Canada; Spine Surgery, St Mary's General Hospital, Kitchener, Ontario, Canada.
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Alsofyani MA, Haignere V, Alsalmi S, Gille O, Vital JM, Pointillart V, Boissière L, Obeid I. Idiopathic Epidural Lipomatosis Associated with Degenerative Discopathy: Grand Round Presentation of Unusual Lumbar Canal Stenosis Resolved by Weight Loss. Asian J Neurosurg 2020; 15:180-183. [PMID: 32181198 PMCID: PMC7057873 DOI: 10.4103/ajns.ajns_255_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/13/2019] [Indexed: 11/30/2022] Open
Abstract
Here, we report a case of idiopathic epidural lipomatosis presented with a clinical picture of lumbar canal stenosis with neurogenic claudication which resolved completely only by weight loss. A 53-year-old obese male with a body mass index of 36 without significant past medical history presented to the outpatient clinic with neurogenic claudication and bilateral sciatic radiculopathy. Initially, magnetic resonance imaging (MRI) showed epidural lipomatosis at the level of L5 vertebral body and L5–S1 intervertebral disc. A conservative treatment was decided with dietary regime program. After 6 months of follow-up, his bilateral sciatic radiculopathy disappeared, and updated MRI showed complete disappearance of epidural lipomatosis. Based on the Grand Round case and relevant literature, we present a case of an unusual epidural lipomatosis with mixed clinical picture of degenerative lumbar disease. This case report set out the importance of Borré classification for differentiating the mixed clinical complaint of degenerative discopathy and epidural lipomatosis.
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Affiliation(s)
- Mohammad A Alsofyani
- Department of Spinal Surgery Unit, Bordeaux University Hospital, Bordeaux University, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France.,Department of Orthopedics, College of Medicine and University Hospital, University of Hail, Hail City, Kingdom of Saudi Arabia
| | - Vincent Haignere
- Department of Spinal Surgery Unit, Bordeaux University Hospital, Bordeaux University, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Sultan Alsalmi
- Department of Neurosurgery, Amiens University Medical Center, Amiens University, Amiens, France.,Department of Neurosurgery, Imam Abdulrahman Bin Faisal University, Dammam City, Kingdom of Saudi Arabia
| | - Olivier Gille
- Department of Spinal Surgery Unit, Bordeaux University Hospital, Bordeaux University, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Jean-Marc Vital
- Department of Spinal Surgery Unit, Bordeaux University Hospital, Bordeaux University, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Vincent Pointillart
- Department of Spinal Surgery Unit, Bordeaux University Hospital, Bordeaux University, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Louis Boissière
- Department of Spinal Surgery Unit, Bordeaux University Hospital, Bordeaux University, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Ibrahim Obeid
- Department of Spinal Surgery Unit, Bordeaux University Hospital, Bordeaux University, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France
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Nagahama Y, Holland MT, Hitchon PW. Spinal epidural lipomatosis due to obesity presenting with back and leg pain and weakness successfully treated with weight loss. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mattei TA, Goulart CR, Rai SS, Rehman AA, Williams M, Mendel E. Rapid Development of Spinal Epidural Lipomatosis after Treatment of Metastatic Castration-Resistant Prostate Cancer with Second-Generation Androgen Receptor Antagonists. World Neurosurg 2019; 125:222-227. [PMID: 30763756 DOI: 10.1016/j.wneu.2019.01.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Previous studies have described the association of spinal epidural lipomatosis with several conditions including chronic steroid therapy, Cushing's syndrome, obesity, Paget disease, and hypothyroidism. We present a report of rapid development of spinal epidural lipomatosis after treatment with second-generation anti-androgen therapy, a new strategy for treatment of metastatic castration-resistant prostate cancer that has been increasingly employed in the past few years. A comprehensive discussion of the underlying molecular networks involving androgen receptor blockage and adipocyte differentiation, as well as the clinical implications of such a phenomenon, are provided. CASE DESCRIPTION We describe the clinical and radiological evolution of a 58-year-old male patient with metastatic prostate cancer, who developed new onset of rapidly progressing lumbosacral epidural lipomatosis with significant compression of the nerve roots of the cauda equina a few months after initiation of treatment with second-generation androgen receptor antagonists. CONCLUSIONS The underlying pathophysiology of adipose tissue growth following the administration of anti-androgen therapy is discussed, with emphasis on both the canonical Wnt/β-catenin pathway as well as in the Wnt-independent pathway involving direct activation of downstream transcription factors from the T-cell factor family by the androgen receptor. As second-generation androgen receptor antagonists have been increasingly used for treatment of castration-resistant stage metastatic prostate cancer, new onset of symptomatic epidural lipomatosis should be considered as a possible differential diagnosis, especially because the urinary symptoms of cauda equina compression may be improperly attributed to the primary prostate neoplasm.
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Affiliation(s)
- Tobias A Mattei
- Department of Neurological Surgery, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
| | - Carlos R Goulart
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Shawn S Rai
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Azeem A Rehman
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Michelle Williams
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ehud Mendel
- Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Park SK, Han JM, Lee K, Cho WJ, Oh JH, Choi YS. The Clinical Characteristics of Spinal Epidural Lipomatosis in the Lumbar Spine. Anesth Pain Med 2018; 8:e83069. [PMID: 30538942 PMCID: PMC6252047 DOI: 10.5812/aapm.83069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/24/2018] [Accepted: 10/09/2018] [Indexed: 11/20/2022] Open
Abstract
Background Spinal epidural lipomatosis (SEL) is a rare disease, defined as diffuse hypertrophy of unencapsulated adipose tissue causing spinal canal compression and progressive neurologic deficits. However, there are few studies on SEL in Korea. Objectives The purpose of this study was to describe the prevalence and clinical characteristics of SEL in Korea. Methods Of the 3702 symptomatic patients (1575 males and 2127 females) who underwent lumbar spine magnetic resonance imaging (MRI) at the age of 20 years or older from January 2014 to December 2016, 42 patients (27 males and 15 females) diagnosed with SEL were selected. Medical records and telephone counseling were used to document sex, age, height, weight, clinical symptoms, coexistent spinal disease, accompanying diseases, and alcoholism and smoking status. One radiologist classified the severity of epidural lipomatosis into three grades from I to III according to Borre et al. We obtained four linear measurements at the axial plane parallel based in the narrowest on MRI image. Results The incidence of SEL in the lumbar spine was 1.1%, which was 1.71% in men and 0.7% in women. The mean age was 69.4 ± 10.9 years and the mean body mass index (BMI) was 26.4 ± 3.5 kg/m2. The most common clinical symptoms were lower back pain and radiating leg pain (26 patients, 61.9%). The level of affected SEL was found to be most prevalent at L5 - S1 (21 patients, 50%). Concomitant diseases were hypertension (26 patients, 61.9%) and diabetes (12 patients, 28.5%). The most common SEL grade was type III (21 patients, 50%), followed by types II (17 patients, 40.4%) and I (4 patients, 9.5%). Conclusions Lumbar spine MRI at one hospital showed that the incidence of symptomatic SEL was 1.1%; SEL is common at the L5-S1 level and in male patients, and severity grade is often severe.
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Affiliation(s)
- Sun Kyung Park
- Department of Anesthesiology and Pain Medicine, Jeju National School of Medicine, Jeju, Korea
- Corresponding Author: Department of Anesthesiology and Pain Medicine, Jeju National School of Medicine, Aran 13gil 15, Jeju-si 63241, Jeju Special Self-Governing Province, Korea. Tel: +82-647172025, E-mail:
| | - Ji Min Han
- Jeju National School of Medicine, Jeju, Korea
| | - Keumo Lee
- Jeju National School of Medicine, Jeju, Korea
| | - Woo Jin Cho
- Department of Anesthesiology and Pain Medicine, Jeju National School of Medicine, Jeju, Korea
| | - Ji Hun Oh
- Department of Anesthesiology and Pain Medicine, Jeju National School of Medicine, Jeju, Korea
| | - Yun Suk Choi
- Department of Anesthesiology and Pain Medicine, Jeju National School of Medicine, Jeju, Korea
- Corresponding Author: Department of Anesthesiology and Pain Medicine, Jeju National School of Medicine, Aran 13gil 15, Jeju-si 63241, Jeju Special Self-Governing Province, Korea. Tel: +82-647172025,
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Theyskens NC, Paulino Pereira NR, Janssen SJ, Bono CM, Schwab JH, Cha TD. The prevalence of spinal epidural lipomatosis on magnetic resonance imaging. Spine J 2017; 17:969-976. [PMID: 28263890 DOI: 10.1016/j.spinee.2017.02.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 02/09/2017] [Accepted: 02/28/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Spinal epidural lipomatosis (SEL) refers to an excessive accumulation of fat within the epidural space. It can be idiopathic or secondary, resulting in significant morbidity. The prevalence of SEL, including idiopathic and secondary SEL, and its respective risk factors are poorly defined. PURPOSE We sought to: (1) assess the prevalence of SEL among patients who underwent a dedicated magnetic resonance imaging (MRI) scan of the spine-including incidental SEL (ie, SEL without any spine-related symptoms), SEL with spine-related symptoms, and symptomatic SEL (ie, with symptoms specific for SEL); and (2) assess factors associated with overall SEL and subgroups. In addition, we assessed differences between SEL subgroups. METHODS We reviewed the records of 28,902 patients, aged 18 years and older with a spine MRI (2004 to 2015) at two tertiary care centers. We identified SEL cases by searching radiology reports for SEL, including synonyms and misspellings. Prevalence numbers were calculated as a percentage of the total number of patients. We used multivariate logistic regression analysis to identify factors associated with overall SEL and subgroups. RESULTS The prevalence of overall SEL was 2.5% (731 of 28,902): incidental SEL, 0.6% (168 of 28,902); SEL with symptoms, 1.8% (526 of 28,902); and symptomatic SEL, 0.1% (37 of 28,902). Factors associated with overall SEL in multivariate analysis were the following: older age (odds ratio [OR]: 1.01, 95% confidence interval [CI]: 1.01-1.02, p<.001), higher modified Charlson comorbidity index (OR: 1.10, 95% CI: 1.07-1.13, p<.001), male sex (OR: 2.01, 95% CI: 1.71-2.37, p<.001), BMI>30 (OR: 2.59, 95% CI: 1.97-3.41, p<.001), Black/African American race (OR: 1.66, 95% CI: 1.24-2.23, p=.001), systemic corticosteroid use (OR: 2.59, 95% CI: 1.69-3.99, p<.001), and epidural corticosteroid injections (OR: 3.48, 95% CI: 2.82-4.30, p<.001). CONCLUSIONS We found that about 1 in 40 patients undergoing a spine MRI had SEL; 23% of whom with no symptoms, 72% with spine-related symptoms, and 5% with symptoms specific for SEL. Our data help identify patients who might warrant an increased index of suspicion for SEL.
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Affiliation(s)
- Nina C Theyskens
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Nuno Rui Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
| | - Stein J Janssen
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Christopher M Bono
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Brigham and Women's Hospital-Harvard Medical School, 75 Francis St, Boston, MA 02115, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Thomas D Cha
- Department of Orthopaedic Surgery, Orthopaedic Spine Service, Massachusetts General Hospital-Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
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Ferlic PW, Mannion AF, Jeszenszky D, Porchet F, Fekete TF, Kleinstück F, Haschtmann D. Patient-reported outcome of surgical treatment for lumbar spinal epidural lipomatosis. Spine J 2016; 16:1333-1341. [PMID: 27363757 DOI: 10.1016/j.spinee.2016.06.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 05/09/2016] [Accepted: 06/22/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal epidural lipomatosis (SEL) is a rare condition characterized by an excessive accumulation of fat tissue in the spinal canal that can have a compressive effect, leading to clinical symptoms. This condition has a distinct pathology from spinal stenosis associated with degeneration of the intervertebral discs, ligaments, and facet joints. Several different conservative and surgical treatment strategies have been proposed for SEL, but its treatment remains controversial. There is a lack of evidence documenting the success of surgical decompression in SEL, and no previous studies have reported the postoperative outcome from the patient's perspective. PURPOSE The aim of the present study was to evaluate patient-rated outcome after surgical decompression in SEL. STUDY DESIGN A retrospective analysis of prospectively collected data was carried out. PATIENT SAMPLE A total of 22 patients (19 males; age: 68.2±9.9 years) who had undergone spine surgery for SEL were identified from our local Spine Surgery Outcomes Database, which includes a total of 10,028 spine surgeries recorded between 2005 and 2012. Inclusion criteria were epidural lipomatosis confirmed by preoperative magnetic resonance imaging (MRI) scans and subsequent decompression surgery without spinal fusion. OUTCOME MEASURES The Core Outcome Measures Index (COMI) was used to assess patient-rated outcome. The COMI includes the domains pain (separate 0-10 scales for back and leg pain), back-specific function, symptom-specific well-being, general quality of life (QOL), work disability, and social disability. METHODS The questionnaires were completed preoperatively and at 3, 12, and 24 months postoperatively. Surgical data were retrieved from the patient charts and from our local Spine Surgery Outcomes Database, which we operate in connection with the International Spine Tango Registry. Differences between pre- and postoperative scores were analyzed using paired t tests and repeated measures analysis of variance. RESULTS At 3-months follow-up, the COMI score and scores for leg pain and back pain had improved significantly compared with their preoperative values (p<.005). The mean decrease in COMI score after 3 months was 2.6±2.4 (range: -1.3 to 6.5) points: from 7.5±1.7 (range: 3.5-10) to 4.9±2.5 (range: 0.5-9.6). A total of 11 patients (50%) had an improvement of the COMI of more than the minimal clinically important change (MCIC) score of 2.2 points. The mean decrease in leg pain after 3 months was 2.4±3.5 (-5 to 10) points. Overall, 17 patients (77.3%) reported a reduced leg pain, 12 (54.6%) of whom by at least the MCIC score of 2 points. The significant reductions from baseline in COMI and leg and back pain scores were retained up to 2 years postoperatively (p<.02). The general QOL item of the COMI improved significantly after surgery (p<.0001). Over 80% of the cohort rated their preoperative QOL as bad (n=13) or very bad (n=5), whereas 3 months after surgery, only 7 patients rated their QOL as bad, and one as very bad (36%). CONCLUSIONS The present study is the first to demonstrate that surgical decompression is associated with a statistically significant improvement in patient-rated outcome scores in patients with symptomatic SEL, with a clinically relevant change occurring in approximately half of them. Surgical decompression hence represents a reasonable treatment option for SEL, although the reason behind the less good response in some patients needs further investigation.
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Affiliation(s)
- Peter W Ferlic
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland; Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria.
| | - Anne F Mannion
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland
| | - Deszö Jeszenszky
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland
| | - François Porchet
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland
| | - Tamás F Fekete
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland
| | - Frank Kleinstück
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland
| | - Daniel Haschtmann
- Spine Center, Schulthess Klinik, Lengghalde 2, 8008 Zürich, Switzerland
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Han SR. Scoliosis associated with idiopathic lumbosacral epidural lipomatosis. JOURNAL OF SPINE SURGERY (HONG KONG) 2016; 2:72-5. [PMID: 27683700 DOI: 10.21037/jss.2016.03.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There are very few reports of spinal epidural lipomatosis (SEL) in association with scoliosis. A 49-year-old man presented with persistent back pain and right hip lump. The lumbar spine X-rays showed scoliosis (Lenke classification 5BN). Lumbar MRI demonstrated circumferential epidural fat deposit from L1 to lower S2 level. There was no obvious etiology of SEL except mild increased body mass index (BMI). The patient was managed with conservative treatment. After 6 months medication (limaprost and ginkgo), his symptoms were relieved.
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Affiliation(s)
- Seong Rok Han
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
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14
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Al-Omari AA, Phukan RD, Leonard DA, Herzog TL, Wood KB, Bono CM. Idiopathic Spinal Epidural Lipomatosis in the Lumbar Spine. Orthopedics 2016; 39:163-8. [PMID: 27018608 DOI: 10.3928/01477447-20160315-04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/23/2015] [Indexed: 02/03/2023]
Abstract
Overgrowth of epidural fat, known as spinal epidural lipomatosis (SEL), can cause symptomatic compression of the spinal cord, conus medullaris, or cauda equina. Suggested predisposing factors such as obesity, steroid use, and diabetes mellitus have been based on a few reported cases, many of which were not surgically confirmed. There is a paucity of epidemiological data in surgically confirmed cases for this disorder. The purpose of this independently reviewed, retrospective, matched cohort analysis was to compare the demographics and incidence of comorbidities of patients who underwent lumbar decompression for SEL vs degenerative stenosis without SEL. Two surgeons' databases were reviewed to identify patients older than 18 years who underwent decompression surgery for magnetic resonance imaging-verified, symptomatic lumbar SEL. A matched control group comprised an equal number of patients with degenerative stenosis (n=14). Demographic data, body mass index, symptom type/duration, comorbidities, complications, treatment history, and associated pathology were collected from medical records. Previously suggested risk factors, such as obesity, endocrinopathy, and epidural steroid injections, were not significantly different between the SEL and control groups. Furthermore, there were no differences in operative times, complications, or blood loss. The only noted difference between the 2 groups was the preoperative duration of symptoms, on average double in patients with SEL. This series represents the largest of its kind reported to date. Because symptom duration was the only difference noted, it is postulated to be the result of lack of awareness of SEL. Future prospective study in a larger group of patients is warranted. [Orthopedics. 2016; 39(3):163-168.].
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15
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Unusual Spinal Epidural Lipomatosis and Lumbosacral Instability. Case Rep Orthop 2016; 2016:3094601. [PMID: 27069704 PMCID: PMC4812222 DOI: 10.1155/2016/3094601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/01/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction. Epidural lipomatosis is most frequently observed in patients on chronic steroid treatment. Only a few idiopathic epidural lipomatosis cases have been described. Material and Methods. 64-year-old male patient presented with low back pain and left leg pain. Later, the patient experienced neurogenic claudication and radicular pain in the left leg without urinary dysfunction. Plain radiography and magnetic resonance imaging demonstrated an abnormal fat tissue overgrowth in the epidural space with compression of the dural sac, degenerative disc disease at L4-L5 level, and instability at L5-S1. Endocrinopathic diseases and chronic steroid therapy were excluded. If conservative treatment failed, surgical treatment can be indicated. Results. After surgery, there was a gradual improvement in symptoms and signs, and six months later the patient returned to daily activities and was neurologically normal. Conclusion. In the absence of common causes of neurogenic claudication, epidural lipomatosis should be considered. The standard test for the diagnosis of epidural lipomatosis is magnetic resonance (MR). At first, conservative treatment must be considered; weight loss and the suspension of prior corticosteroid therapy are indicated. In the presence of neurological impairment, the operative treatment of wide surgical decompression must be performed soon after diagnosis.
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Ahmadzai H, Khalil A, Mitchell RA, Kwok B. An unusual case of spinal cord compression from concomitant spinal epidural lipomatosis and Hodgkin's lymphoma. J Surg Case Rep 2016; 2016:rjw025. [PMID: 26962199 PMCID: PMC4783626 DOI: 10.1093/jscr/rjw025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spinal epidural lipomatosis (SEL) results from an abnormal accumulation of unencapsulated fat within the epidural space and is a rare cause of spinal cord compression, which needs to be considered with a high index of suspicion. It most commonly occurs secondary to chronic corticosteroid use and endocrinopathies. Idiopathic cases are highly associated with obesity. We report an unusual case of idiopathic thoracic SEL in a 69-year-old male, with an adjacent infiltrative Hodgkin's lymphoma and associated vertebral crush fracture, which resulted in ataxia and sensory loss. Magnetic resonance imaging scans displayed extensive SEL and an infiltrative disease process causing thoracic cord compression. Surgical decompression confirmed the presence of extensive epidural lipomatosis and Hodgkin's lymphoma and subsequently led to improvement in neurological symptoms. To our knowledge, this is the first reported case of concomitant SEL with an adjacent Hodgkin's lymphoma resulting in cord compression.
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Affiliation(s)
- Hasib Ahmadzai
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, NSW, Australia Department of Neurology and Neurosurgery, St. George Hospital, Kogarah, NSW, Australia
| | - Ali Khalil
- Department of Neurology and Neurosurgery, St. George Hospital, Kogarah, NSW, Australia Faculty of Medicine, Deakin University, Geelong, VIC, Australia
| | - Ruth A Mitchell
- Department of Neurology and Neurosurgery, St. George Hospital, Kogarah, NSW, Australia
| | - Bernard Kwok
- Department of Neurology and Neurosurgery, St. George Hospital, Kogarah, NSW, Australia
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