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D’Agostino V, Petrera MR, Tedesco G, Pipola V, Ponti F, Spinnato P. Could Spinal Epidural Lipomatosis Be the Hallmark of Metabolic Syndrome on the Spine? A Literature Review with Emphasis on Etiology. Diagnostics (Basel) 2023; 13:diagnostics13020322. [PMID: 36673132 PMCID: PMC9858169 DOI: 10.3390/diagnostics13020322] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/22/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
Spinal epidural lipomatosis is defined by an excessive amount of epidural fat in the spinal canal, usually in the lumbosacral tract: a well-known cause of lumbar pain and spinal stenosis with a possible wide range of neurological symptoms. Recent research data reveal that, nowadays, obesity has become the main cause of spinal epidural lipomatosis. Moreover, this condition was recently recognized as a previously unknown manifestation of metabolic syndrome. Radiological studies (CT and MRI) are the only tools that are able to diagnose the disease non-invasively. Indeed, radiologists play a key role in disease recognition, with subsequent possible implications on patients' systemic health assessments. Despite its clinical importance, the condition is still underreported and neglected. The current literature review summarizes all the main etiologies of spinal epidural lipomatosis, particularly regarding its linkage with metabolic syndrome. An overview of disease characteristics from diagnosis to treatment strategies is also provided.
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Affiliation(s)
- Valerio D’Agostino
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Miriana Rosaria Petrera
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giuseppe Tedesco
- Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Valerio Pipola
- Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence: or
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Neal MT, Patra DP, Lyons MK. Surgical management of thoracic myelopathy from long-segment epidural lipomatosis with skip hemilaminotomies: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21595. [PMID: 35855484 PMCID: PMC9281437 DOI: 10.3171/case21595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thoracic spinal epidural lipomatosis (SEL) involves the pathological overgrowth of histologically normal, unencapsulated adipose tissue that can compress the spinal cord and cause myelopathy. SEL has been associated with multiple medical conditions, including Scheuermann kyphosis (SK). Optimal treatment strategies for SEL, especially in the setting of a sagittal spinal deformity, remain unclear. OBSERVATIONS In this report, the authors discussed surgical management of a patient with thoracic SEL and SK using skip hemilaminotomies for resection of the epidural adipose tissue. To the authors’ knowledge, only one other report described a similar surgical technique in a patient who did not have a spinal deformity. LESSONS When conservative efforts fail, thoracic SEL may require surgical treatment. Surgical planning must account for co-medical conditions such as SK. The described approach involving skip laminotomies, which minimizes spine destabilization, is a viable option to treat SEL spanning multiple spinal segments. Prognosis after surgical treatment varies and is impacted by multiple factors, including severity of preoperative neurological deficits.
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Affiliation(s)
| | - Devi P. Patra
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona
| | - Mark K. Lyons
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona
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Walker PB, Sark C, Brennan G, Smith T, Sherman WF, Kaye AD. Spinal Epidural Lipomatosis: A Comprehensive Review. Orthop Rev (Pavia) 2021; 13:25571. [PMID: 34745483 DOI: 10.52965/001c.25571] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/03/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose of review This is a comprehensive review regarding the epidemiology, diagnosis, and management of spinal epidural lipomatosis (SEL). Recent Findings SEL is a relatively rare condition that has gained scientific relevance over the past few decades. Recent findings include expanding treatment strategies to include minimally invasive surgical techniques. Summary SEL is caused by an excess of adipose tissue accumulation localized to the thoracic and lumbar regions of the spine. While the exact pathogenesis is not fully elucidated, the etiology of SEL can be broadly classified based on five commonly associated risk factors; exogenous steroid use, obesity, endogenous steroid hormonal disease, spine surgery, and idiopathic disease. Progression of SEL may lead to neurological deficits, myelopathy, radiculopathy, neurogenic claudication, loss of sensation, difficulty voiding, lower extremity weakness, and rarely cauda equina syndrome. Conservative management is largely patient-specific and aimed at mitigating symptoms that arise from shared risk factors. If more advanced treatment measures are necessary, minimally invasive surgery and open surgical techniques, have proven successful.
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Affiliation(s)
| | - Cain Sark
- Louisiana State University Health Science Center Shreveport
| | - Gioe Brennan
- Louisiana State University Health Science Center Shreveport
| | - Taylor Smith
- Louisiana State University Health Science Center Shreveport
| | | | - Alan D Kaye
- Louisiana State University Health Science Center Shreveport
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Two-year outcome comparison of decompression in 14 lipomatosis cases with 169 degenerative lumbar spinal stenosis cases: a Swiss prospective multicenter cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2243-2253. [PMID: 32409888 DOI: 10.1007/s00586-020-06449-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/09/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Spinal epidural lipomatosis (SEL) is defined as an abnormal and extensive accumulation of unencapsulated adipose tissue within the spinal epidural space. To date, there is a lack of high-level evidence studies reporting the outcome of surgical treatment of symptomatic SEL in patients with lumbar spinal stenosis (LSS). The aim was to compare clinical outcomes in patients with symptomatic LSS with and without SEL who underwent decompression surgery alone at the 12- and 24-month follow-up. METHODS One hundred and eighty-three patients met the inclusion criteria, of which 14 had mainly SEL on at least one level operated in addition to possible degenerative changes on other levels and 169 degenerative LSS only. The main outcomes were pain (Spinal Stenosis Measure (SSM) symptoms), disability (SSM function), and quality of life [EQ-5D-3L summary index (SI)] at 24-month follow-up, and minimal clinically important difference (MCID) in SSM symptoms, SSM function, and EQ-5D-3L SI. RESULTS The multiple regression linear models showed that SEL was associated with worse SSM symptoms (p = 0.045) and EQ-5D-3L SI scores (p = 0.026) at 24-month follow-up, but not with worse SSM function scores. Further, depression (in all models) was negatively associated with better clinical outcomes at 24-month follow-up. In the outcomes SSM symptoms and EQ-5D-3L SI, distinctly more patients in the classical LSS group reached MCID than in the SEL group (71.3% and 62.3% vs. 50.0% and 42.9%). CONCLUSIONS Our study demonstrated that decompression alone surgery was associated with significant improvement in disability in both groups at 2 years, but not in pain and quality of life in patients with SEL.
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Bhalla S, Puri V, Skjei K. Spinal Epidural Lipomatosis: A Rare Complication From Hormonal Therapy for Infantile Spasms. Pediatr Neurol 2019; 101:78-80. [PMID: 31444013 DOI: 10.1016/j.pediatrneurol.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/08/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Spinal epidural lipomatosis (SEL) represents pathologic overgrowth of extradural adipose tissue in the spinal canal that can result in spinal cord compression. SEL has been associated with excess corticosteroids, whether from exogenous steroid use or from excess endogenous steroids. Spinal epidural lipomatosis is rarely reported in children and has not been reported in association with hormonal therapy for infantile spasms. METHODS We performed a detailed retrospective chart and literature review. RESULTS We describe two children with symptomatic SEL associated with the use of high-dose hormone treatment for infantile spasms.
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Affiliation(s)
- Sonam Bhalla
- Division of Child Neurology, University of Louisville, Louisville, Kentucky; Department of Neurology, Columbia University Medical Center, New York City, New York.
| | - Vinay Puri
- Division of Child Neurology, University of Louisville, Louisville, Kentucky
| | - Karen Skjei
- Division of Child Neurology, University of Louisville, Louisville, Kentucky
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Kim K, Mendelis J, Cho W. Spinal Epidural Lipomatosis: A Review of Pathogenesis, Characteristics, Clinical Presentation, and Management. Global Spine J 2019; 9:658-665. [PMID: 31448201 PMCID: PMC6693071 DOI: 10.1177/2192568218793617] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Narrative review of available literature. OBJECTIVE To summarize current trends in pathogenesis and management of spinal epidural lipomatosis (SEL) and suggest areas where more research would be of benefit. METHODS The available literature relevant to SEL was reviewed. PubMed, Medline, OVID, EMBASE, Cochrane, and Google Scholar were used to review the literature. Institutional review board approval is not applicable for this study. RESULTS This article clearly summarizes current trends in the pathogenesis and management of SEL. CONCLUSIONS Possible etiologies of SEL include exogenous steroid use, endogenous steroid hormonal disease, obesity, surgery induced, and idiopathic disease. Comorbidities such as acquired immunodeficiency syndrome and Scheuermann's disease have also been implicated in the pathogenesis of SEL. Steroid-induced SEL seems to have a proclivity for the thoracic region of the spine and has a higher incidence of paraplegia when compared with other forms. Several treatment modalities exist for SEL and are dictated by the underlying cause of the disorder. These include weight reduction, cessation of steroid medications, treatment of underlying endocrine abnormalities, and surgical decompression. Conservative treatments generally aim to decrease the thickness of adipose tissue in the epidural space, but the majority of patients tend to undergo surgical decompression to relieve neurologic symptoms. Surgical decompression provides a statistically significant reduction in symptoms, but postoperative mortality is high, influenced primarily by the patient's preoperative comorbidities. Physicians should consider the underlying cause of SEL in a given patient before pursuing specific treatment modalities, but alarm symptoms, such as the development of acute cauda equina syndrome, should likely be treated with urgent surgical decompression.
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Affiliation(s)
- Keonhee Kim
- Yonsei University, Seoul, Republic of Korea,Severance Hospital, Seoul, Republic of Korea
| | - Joseph Mendelis
- Albert Einstein College of Medicine, Bronx, NY, USA,Montefiore Medical Center, Bronx, NY, USA
| | - Woojin Cho
- Albert Einstein College of Medicine, Bronx, NY, USA,Montefiore Medical Center, Bronx, NY, USA,Woojin Cho, Montefiore Medical Center, Montefiore
Green Medical Arts Pavilion, 3400 Bainbridge Ave, 6th Floor, Bronx, NY 10467-2404, 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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Awwad A, Ibrahem Adam RE, Patel C, Thomas JD. Symptomatic spinal epidural lipomatosis after combined hormonal and steroidal palliative therapy of prostate cancer. Spinal Cord Ser Cases 2018; 4:75. [PMID: 30109139 DOI: 10.1038/s41394-018-0107-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/30/2018] [Accepted: 06/30/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction Spinal epidural lipomatosis (SLE) is an abnormal accumulation of unencapsulated fat. The association of chronic steroid therapy is described as well as obesity and Cushing's syndrome. SLE has a range of neurological presentations such as back pain, myelopathy, and cauda equina syndrome. Surgical decompression is known to improve symptomatic cases and prevent further deterioration. Case presentation An elderly male patient with background history of high-risk metastatic prostate cancer and long-term treatment with steroids and hormonal therapy presented with acute on chronic back pain and neurological symptoms. Spinal cord compression was excluded on the subsequent MRI. However, a spinal epidural lipomatosis causing significant central canal stenosis and compression of the cauda equine was revealed. Discussion With the increasing role of MRI in assessing back pain, asymptomatic spinal epidural lipomatosis has been frequently noticed. However, symptomatic presentation after long term combined treatment of steroids and hormonal therapy has not been reported in the literature.
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Affiliation(s)
- Amir Awwad
- 1NIHR Nottingham Biomedical Research Centre, Sir Peter Mansfield Imaging Centre (SPMIC), University of Nottingham, Nottingham, NG72UH UK.,2Radiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, CB23 3RE UK
| | - Renan E Ibrahem Adam
- 3Radiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH UK
| | - Chandni Patel
- 4Urology Department, Nottingham Urology Centre, City Hospital, Nottingham, NG5 1PB UK
| | - James D Thomas
- 3Radiology Department, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH UK
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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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Spinal epidural lipomatosis - an easily ignored secondary intraspinal disorder in spinal kyphotic deformities. BMC Musculoskelet Disord 2017; 18:112. [PMID: 28302104 PMCID: PMC5356279 DOI: 10.1186/s12891-017-1467-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/18/2017] [Indexed: 11/16/2022] Open
Abstract
Background A previous study reported a high prevalence of spinal epidural lipomatosis (SEL) in patients with Scheuermann kyphosis (SK) and suggested that it may play a role in the pathogenesis of this disease. According to our observation, however, SEL occurs in other spinal kyphotic deformities as well. The aim of this study was to test the hypothesis that SEL commonly occurs in patients with different types of kyphotic deformities as a secondary intraspinal disorder. Methods MR images of 16 patients with congenital kyphosis (CK), 40 patients with SK, 13 patients with tuberculotic kyphosis (TK), and 69 age- and sex-matched controls were retrospectively evaluated. The body mass index (BMI), kyphosis Cobb angle, and sagittal diameters of spinal epidural fat (EF) and the dural sac (DS) in the apical region (EFA, DSA) and non-kyphotic region (EFN, DSN) were measured. The EF ratios at the apical vertebral level (EFRA) and in the non-kyphotic region (EFRN) were calculated as EF / (EF + DS). Results EFA and EFRA were significantly higher among patients with CK, SK, and TK than among controls (P < 0.05). Seven CK patients (43.8%), 8 SK patients (20.0%), and 11 TK patients (84.6%) fulfilled the diagnostic criteria for SEL, while only 6.3, 2.5, and 0% of patients in the control groups did (P = 0.019, 0.014, and < 0.001, respectively). Spearman’s correlation analysis showed statistically significant correlations between the kyphosis Cobb angle and the amount of EF in all three patient groups. Conclusions SEL is a common secondary intraspinal disorder in different types of kyphotic deformities, and surgeons should pay increased attention to this intraspinal anomaly because excessive EF may compress the spinal cord and cause neurological deficits.
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Kim SS, Lim DJ. Epidural lipomatosis with cauda equina syndrome in chronic alcoholic patient: A case report. Int J Surg Case Rep 2017; 33:12-15. [PMID: 28259071 PMCID: PMC5334492 DOI: 10.1016/j.ijscr.2017.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 11/20/2022] Open
Abstract
Case of epidural lipomatosis with cauda equina syndrome in chronic alcoholic patient is provided. Posterior decompression was applied and neurologic deficit was significantly recovered. MRI is the best imaging tool of choice. Short T1 inversion recovery (STIR) sequence may be useful for confirmation of diagnosis as lipid is hypointense in this sequence.
Introduction Epidural lipomatosis of the lumbar spine is a rare condition, which is described as the accumulation of fat in the extradural territory. Presentation of case We report the case of a 60-year-old, non-obese, and chronic alcoholic man who was transferred to our spine department with cauda equina syndrome (CES) for 4 months. On magnetic resonance imaging (MRI), spinal epidural lipomatosis (SEL) was confirmed in the multilevel lumbar lesion. A decompression surgery was performed and the patient recovered significantly. Discussion The patient was not obese, had no abnormal liver laboratory test results, and no history of steroid injection or administration. The clinical signs at onset suggested bilateral lower cauda equina dysfunction, indicating a more diffuse involvement, consistent with lumbosacral epidural lipomatosis. Conclusion This case report is the first description of SEL in a non-obese, chronic alcoholic patient who was neither receiving steroids nor had any kind of endocrinopathy.
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Affiliation(s)
- Sung-Soo Kim
- Department of Orthopaedic Surgery, Spine Center, Haeundae-paik Hospital, Inje University College of Medicine, Republic of Korea
| | - Dong-Ju Lim
- Department of Orthopaedic Surgery, Seoul Spine Institute, Sanggye-paik Hospital, Inje University College of Medicine, Republic of Korea.
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