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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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Liu Z, Wang Y, Ma X, Zhang L, Wang C. Role of epidural fat in the local milieu: what we know and what we don't. Connect Tissue Res 2024; 65:102-116. [PMID: 38493368 DOI: 10.1080/03008207.2024.2329871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Traditionally, the epidural fat (EF) is known as a physical buffer for the dural sac against the force and a lubricant facilitating the relative motion of the latter on the osseous spine. Along with the development of the studies on EF, controversies still exist on vital questions, such as the underlying mechanism of the spinal epidural lipomatosis. Meanwhile, the scattered and fragmented researches hinder the global insight into the seemingly dispensable tissue. METHODS Herein, we reviewed literature on the EF and its derivatives to elucidate the dynamic change and complex function of EF in the local milieu, especially at the pathophysiological conditions. We start with an introduction to EF and the current pathogenic landscape, emphasizing the interlink between the EF and adjacent structures. We generally categorize the major pathological changes of the EF into hypertrophy, atrophy, and inflammation. RESULTS AND CONCLUSIONS It is acknowledged that not only the EF (or its cellular components) may be influenced by various endogenic/exogenic and focal/systematic stimuli, but the adjacent structures can also in turn be affected by the EF, which may be a hidden pathogenic clue for specific spinal disease. Meanwhile, the unrevealed sections, which are also the directions the future research, are proposed according to the objective result and rational inference. Further effort should be taken to reveal the underlying mechanism and develop novel therapeutic pathways for the relevant diseases.
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Affiliation(s)
- Zhiming Liu
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yida Wang
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuexiao Ma
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lu Zhang
- Department of Medical Research Center, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chao Wang
- Department of Spine Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
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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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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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Yu Y, Jiang Y, Xu F, Yuan L, Mao Y, Li C. Percutaneous full-endoscopic uniportal decompression for the treatment of symptomatic idiopathic lumbar spinal epidural lipomatosis: Technical note. Front Surg 2022; 9:894662. [PMID: 36147697 PMCID: PMC9485546 DOI: 10.3389/fsurg.2022.894662] [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] [Received: 03/12/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022] Open
Abstract
Background Lumbar spinal epidural lipomatosis (SEL) is a rare condition characterized by an excessive accumulation of adipose tissue within the spinal canal, compressing the dura sac and/or nerve roots. When conservative treatments fail and clinical symptoms progress quickly and seriously, surgical decompression should be considered. With the rapid development of endoscopic armamentaria and techniques, the pathological scope that can be treated by percutaneous endoscopic spine surgery is ever expanding. Objective In this paper, the authors describe a patient with lumbar spinal epidural lipomatosis who was treated with a percutaneous full-endoscopic uniportal decompression surgery successfully. This article aims to validate the feasibility of percutaneous full-endoscopic uniportal decompression for the treatment of symptomatic idiopathic spinal epidural lipomatosis via interlaminar approach. Methods We describe a case of a 69-year-old man with a 10-year history of low back pain, intermittent claudication, and bilateral leg neuropathic pain. He was diagnosed with lumbar epidural lipomatosis, which did not respond to conservative therapy. After a comprehensive evaluation, he underwent percutaneous endoscopic spine surgery to remove hyperplastic adipose tissue and decompress nerve roots and dura sac. Results The patient was treated with a percutaneous full-endoscopic uniportal decompression surgery successfully. After the procedure, his leg pain decreased and his walking capacity improved. There were no surgery-related complications, such as cerebrospinal fluid leakage, incision infection, etc. Conclusions The case with SEL was successfully treated with a percutaneous full-endoscopic uniportal surgery, which has the advantages of excellent presentation of anatomical structures, expanded field of vision, less surgical-related trauma, and bleeding. The key point of the procedure is to release and cut off the bands which divide the epidural space into small rooms filled with excess adipose tissue.
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Affiliation(s)
- Yong Yu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Correspondence: Yong Yu
| | - Ye Jiang
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Fulin Xu
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Lutao Yuan
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Yuhang Mao
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
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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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Manjila S, Fana M, Medani K, Kay MD, Manjila R, Bazil TG, Udayasankar U. Spinal Epidural Lipomatosis Causing Lumbar Canal Stenosis: A Pictorial Essay on Radiological Grading and the Role of Bariatric Surgery Versus Laminectomy. Cureus 2022; 14:e26492. [PMID: 35919217 PMCID: PMC9339211 DOI: 10.7759/cureus.26492] [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] [Accepted: 06/30/2022] [Indexed: 12/01/2022] Open
Abstract
Spinal epidural lipomatosis (SEL) is a rare condition characterized by an excessive accumulation of adipose tissue in the spinal canal that can have a compressive effect on intraspinal neuroanatomical structures, leading to clinical symptoms. Several different conservative and surgical treatment strategies have been proposed but the treatment and outcomes remain controversial. There is a lack of severity-based evidence documenting the success of decompressive laminectomy in SEL and there are only anecdotal reports of clinico-radiological success with weight loss from bariatric surgery. This article demonstrates the resolution of SEL in two patients with bariatric surgery with the help of pre and postoperative MR imaging. The authors also highlight the classic “types” of spinal epidural lipomatosis with a surgically relevant grading system and elucidate the existence of concurrent extraspinal lipomatosis (i.e. mediastinal and intra-abdominal lipomatosis), drawing parallels with the natural history of SEL. The controversial question remains whether a symptomatic SEL patient needs a multilevel laminectomy for spinal decompression or bariatric surgery that can indirectly help the spinal condition. We propose that bariatric intervention could be better frontline management in patients with multifocal/multisystem lipomatosis (i.e., combined spinal and extraspinal) and spinal decompression would be ideal for those SEL patients with coexisting bony and/or ligamentous spinal canal or foraminal stenosis. This manuscript serves as a comprehensive and contemporary update on the radiological profile and two plausible treatment paths and will look toward further verification by a randomized clinical trial.
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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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Zhang B, Yuan H, Hu L, Saad M. Obesity is a risk factor for epidural lipomatosis: a meta-analysis. J Orthop Surg (Hong Kong) 2021; 29:23094990211027391. [PMID: 34323151 DOI: 10.1177/23094990211027391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The purpose of this meta-analysis was to summarize the evidence of associations between obesity factors and spinal epidural lipomatosis (SEL) and to evaluate the strength and validity of these associations. METHODS Electronic databases such as Wiley Online Library, PubMed, Embase, Cochrane Library were searched and manual retrieval of references, the time limit was from the establishment of the database to May 2020. Methodological quality evaluations of the included studies were assessed using the bias risk assessment tool recommended by the Cochrane Guidelines. The RevMan 5.3 software was used for meta-analysis. RESULTS Finally, seven studies were included for meta-analysis, all of which were observational studies with mixed bias risk. These studies involved 807 patients, with an average age of 64 to 73.6 years, and 59.4 percent of the participants were male. The sample sizes for the included studies ranged from 28 to 288. The results of meta-analysis showed that high body mass index (BMI) was one of the factors affecting SEL (P < 0.01, MD 1.37, 95% CI [0.81, 1.92]). All reviews had a high risk of bias, and the most common source of bias was that there was no strict unified case diagnosis standard between researches, and some studies (four items) did not clearly describe the confounders that they controlled. CONCLUSIONS We suggest that physicians should consider high BMI as a factor leading to SEL, and to control body weight actively should be considered as the preferred treatment strategy before surgical intervention is conducted.
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Affiliation(s)
- Bi Zhang
- Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China.,Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, People's Republic of China
| | - Haifeng Yuan
- Department of Spine Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
| | - Lihong Hu
- Department of Spine Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
| | - Muhammad Saad
- Ningxia Medical University, Yinchuan, Ningxia, People's Republic of China
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Fujita N. Lumbar Spinal Canal Stenosis from the Perspective of Locomotive Syndrome and Metabolic Syndrome: A Narrative Review. Spine Surg Relat Res 2020; 5:61-67. [PMID: 33842711 PMCID: PMC8026207 DOI: 10.22603/ssrr.2020-0112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/20/2020] [Indexed: 11/05/2022] Open
Abstract
Patients with lumbar spinal canal stenosis (LSS) have impaired activities of daily living because of pain or motor paralysis, but no effective preventive treatment is currently available. The number of patients with LSS is predicted to continually increase as the average age of the global population increases. To provide a conceptual framework for improving healthy life expectancy, the Japanese Orthopaedic Association introduced the concept of locomotive syndrome, to which LSS is related. Ours and other studies have shown that LSS exacerbates locomotive syndrome and that surgical treatment is one method for improving it. Furthermore, we propose that the two-step test, a locomotive syndrome risk test, is effective for assessing the risk for falls and severity of LSS. Meanwhile, lumbar spinal epidural lipomatosis (LSEL), which is a manifestation of LSS, has been shown to be related to metabolic syndrome. Previous studies have suggested that the whole LSS can be also associated with metabolic syndrome. Although locomotive syndrome is very different from metabolic syndrome, which involves lipid metabolism, these two syndromes overlap, such as in LSS. Conducting research on LSS from the perspectives of both locomotive syndrome and metabolic syndrome may lead to novel methods for prevention and treatment of LSS and, conversely, may yield clues for resolving symptoms of the two syndromes. This review provides an overview of LSS from the perspective of locomotive syndrome and metabolic syndrome, along with findings from our research group.
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Affiliation(s)
- Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, Aichi, Japan
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Chaudhary K, Chandy D, Agrawal V, Dhawale A, Nagaonkar S. Spinal Epidural Lipomatosis with Osteoporotic Vertebral Fractures Presenting as Acute Thoracic Myelopathy in a 33-Year-Old Man with Cushing Disease. World Neurosurg 2020; 142:136-141. [PMID: 32634631 DOI: 10.1016/j.wneu.2020.06.212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/26/2020] [Accepted: 06/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Steroid-related spinal epidural lipomatosis (SEL) is a well-known condition most commonly encountered in patients taking chronic steroid medications. Endogenous Cushing syndrome is a rare cause of SEL. The authors report an unusual presentation of acute thoracic myelopathy due to SEL with osteoporotic vertebral compression fractures in a patient with Cushing disease. CASE DESCRIPTION A 33-year-old man presented with thoracic myelopathy due to SEL and multiple vertebral compression fractures. He had Cushingoid clinical features, and investigations revealed a pituitary microadenoma as the cause of hypercortisolism. The diagnosis was missed on multiple occasions before the onset of paraparesis. The patient was treated with urgent thoracic laminoplasty followed by transsphenoidal surgery on the same day. Although normalization of the serum cortisol levels was delayed by 6 months, he had a complete neurologic recovery and remains symptom free at 2 years follow-up. CONCLUSIONS This is a rare presentation of Cushing disease and has been reported only twice before in the 1990s. This case highlights the need to keep a high degree of suspicion for development of thoracic myelopathy in a patient with Cushing syndrome who develops thoracic compression fractures associated with SEL. Early recognition of this clinical association and addressing the primary endocrine problem urgently could have prevented spinal cord involvement and the subsequent spine surgery. This scenario is also documented in previous published case reports of this association where the diagnosis of Cushing syndrome has been revealed retrospectively after the development of neurologic symptoms.
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Affiliation(s)
- Kshitij Chaudhary
- Department of Orthopaedics and Spine Surgery, Sir HN Reliance Foundation Hospital and Research Center, Mumbai, Maharashtra, India.
| | - David Chandy
- Department of Endocrinology, Sir HN Reliance Foundation Hospital and Research Center, Mumbai, Maharashtra, India
| | - Vivek Agrawal
- Department of Neurosurgery, Sir HN Reliance Foundation Hospital and Research Center, Mumbai, Maharashtra, India
| | - Arjun Dhawale
- Department of Orthopaedics and Spine Surgery, Sir HN Reliance Foundation Hospital and Research Center, Mumbai, Maharashtra, India
| | - Smita Nagaonkar
- Department of Otolaryngology, Sir HN Reliance Foundation Hospital and Research Center, Mumbai, Maharashtra, India
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Youn MS, Woo YH, Shin JK. Rapid progression of spinal epidural lipomatosis after percutaneous endoscopic spine surgery mimicking disc herniation. Int J Surg Case Rep 2020; 73:1-4. [PMID: 32622184 PMCID: PMC7334442 DOI: 10.1016/j.ijscr.2020.06.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/18/2020] [Accepted: 06/18/2020] [Indexed: 01/01/2023] Open
Abstract
Spinal epidural lipomatosis can occur and progress rapidly after endoscopic spine surgery. As in our case, focally progressed SEL anterior to the dural sac could be misdiagnosed for disc herniation. SEL should be recognized as a rare complication of endoscopic spine surgery.
Introduction Spinal epidural lipomatosis (SEL) is well known but uncommon complication of endoscopic spine surgery. Here, we present a case of SEL that progressed focally and rapidly after endoscopic spinal surgery. Presentation of case A 67-year-old man presented with back and Lt. leg radiating pain. MRI of the lumbar spine demonstrated severe foraminal stenosis at Lt. L4/5/S1. He underwent endoscopic posterior foraminotomy at Lt. L4/5/S1. After surgery, his leg pain disappeared. A month after surgery, the patient developed Lt. leg pain again. MR images showed focally progressed epidural fat posterior to the L5 body. After removal of lipomatosis via endoscopic posterior decompression at L3/4/5, his symptoms improved. Discussion Mostly, the epidural fat accumulates insidiously, and distributes widely across several levels. And the increased accumulation of fat is predominantly posterior and posterolateral within the spinal canal. As in this case, focally progressed SEL anterior to the dural sac is rare. And focally progressed SEL can be misdiagnosed for disc herniation. Conclusion SEL should be recognized as a rare complication of endoscopic spine surgery.
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Affiliation(s)
- Myung Soo Youn
- Department of Orthopaedic Surgery, Busan Keun Hospital, 494 Gayadae-ro, Jin-gu, Busan, 47324, South Korea
| | - Young Ha Woo
- Department of Orthopaedic Surgery, Busan Keun Hospital, 494 Gayadae-ro, Jin-gu, Busan, 47324, South Korea
| | - Jong Ki Shin
- Department of Orthopaedic Surgery, Dongeui Medical Center, 62 Yangjung-ro, Jin-gu, Busan, 47227, South Korea.
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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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Arora M, Leever JD. Thoracic epidural lipomatosis associated with syrinx: A case report. Radiol Case Rep 2020; 15:528-530. [PMID: 32153693 PMCID: PMC7057158 DOI: 10.1016/j.radcr.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 11/15/2022] Open
Abstract
Epidural lipomatosis with associated syrinx formation is an exceedingly rare clinical entity. In this case report we present a 48-year old female who initially presented with symptoms of progressive myelopathy and later developed urinary incontinence. Her imaging studies showed upper thoracic epidural lipomatosis and associated spinal stenosis, cord compression and a mildly expansile right paracentral syrinx at C7-T1. She underwent a decompression surgery which provided her with partial symptomatic relief. On MRI, there was a mild decrease in the size of syrinx and some improvement in the degree of spinal stenosis. However, the subsequent clinical improvement supported the possibility that spinal compression caused by epidural lipomatosis could have resulted in syrinx formation. Therefore, such cases can be appropriately treated with spinal decompression surgeries or syrinx shunting procedures.
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Affiliation(s)
- Manasi Arora
- Corresponding author: Lady Hardinge Medical College, University of Delhi, Connaught Place, New Delhi, Delhi 110001, India.
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15
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Chen Y, Hu Z, Li Z, Fan S, Zhao X, Song L, Wang L. An investigation and validation of CT scan in detection of spinal epidural adipose tissue. Medicine (Baltimore) 2020; 99:e19448. [PMID: 32150099 PMCID: PMC7478604 DOI: 10.1097/md.0000000000019448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To investigate the accuracy of computed tomography (CT) in evaluating spinal epidural adipose tissue compared to magnetic resonance imaging (MRI).CT scan images and matched magnetic resonance images of total 368 patients between July 2014 and July 2016 were evaluated. Hounsfield units (HU) of epidural fat (EF), dural sac (DuS), ligamentum flavum, bone of facet joints, and paraspinal muscles were measured for comparison. Anteroposterior diameter of the EF, anteroposterior diameter of the DuS, transverse diameter of the DuS, cross-sectional area of the EF, and cross-sectional area of the DuS were measured at each disc level from L1-2 to L5-S1.Fat tissue showed exclusive negative HU significantly different from all other periphery tissues. Pearson correlation coefficient analyses showed significant positive correlations between CT and MRI measurements; Bland-Altman plots also depicted satisfied agreement. Overgrowth of spinal EF was more commonly found at L2-3 and L3-4 levels in present study, and body weight, age, and gender were significantly associated with amounts of EF both on CT and MRI.The CT scan is a satisfied alternative of MRI for the evaluation of spinal epidural adipose tissue.
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Affiliation(s)
- Yilei Chen
- Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Ziang Hu
- Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Zhaozhi Li
- Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Shunwu Fan
- Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Xing Zhao
- Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Lijiang Song
- Department of Orthopaedics Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University
| | - Lili Wang
- School of Statistics and Mathematics, Zhejiang Gongshang University, Hangzhou, PR China
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Lotan I, Charlson RW, Fatterpekar GM, Shapiro M, Smith ML, William C, Kister I. Progressive myelopathy associated with spinal epidural lipomatosis in three non-obese patients with type 1 diabetes mellitus. J Neurol Sci 2020; 411:116688. [PMID: 31972349 DOI: 10.1016/j.jns.2020.116688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Spinal epidural lipomatosis (SEL) is a rare condition defined as pathological overgrowth of the normally present epidural fat within the spinal canal. SEL is associated with Cushing disease, obesity and chronic corticosteroid therapy. Diabetes mellitus type 1 (DM1) has not known to be a risk factor for SEL. The neurological symptoms of SEL are attributed mainly to mechanical compression on the spinal cord and the cauda equina. METHODS A retrospective chart review of patients evaluated at NYU Multiple Sclerosis Care Center identified three diabetic patients with progressive myelopathy associated with SEL. We report the clinical course, diagnostic workup and outcomes in these three patients with SEL-associated myelopathy. RESULTS Three patients (2 females and 1 male) had long-standing DM1 and developed progressive myelopathy in their early 40's. All were found to have thoracic SEL (extensive extradural T1, T2 hyperintense signal; biopsy confirmed in one case) with associated extensive abnormal cord signal in lower cervical/upper thoracic spinal cord. A comprehensive evaluation for metabolic, infectious, autoimmune and vascular causes of myelopathy that included serologies, cerebrospinal fluid analyses, and spinal angiography did not reveal an alternative cause for myelopathy. One of the patients underwent a surgical decompression of SEL with subsequent clinical and radiologic improvement. CONCLUSIONS Our case series suggest that patients with DM1 and myelopathy of unknown cause should be evaluated for SEL. Timely diagnosis and appropriate intervention may forestall progression of neurological disability and even result in neurologic improvement. SEL should be considered on the short list of diagnoses that cause potentially reversible progressive myelopathy.
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Affiliation(s)
- Itay Lotan
- Department of Neurology, Multiple Sclerosis Comprehensive Care Center, NYU Langone Medical Center, New York, NY, United States of America; Department of Neurology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Robert W Charlson
- Department of Neurology, Multiple Sclerosis Comprehensive Care Center, NYU Langone Medical Center, New York, NY, United States of America
| | - Girish M Fatterpekar
- Department of Radiology, NYU Langone Medical Center, New York, NY, United States of America
| | - Maksim Shapiro
- Department of Radiology, Neurointerventional Radiology Section, NYU School of Medicine, New York, NY, United States of America
| | - Michael L Smith
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY, United States of America
| | - Christopher William
- Department of Pathology, New York University School of Medicine, New York, NY, United States of America
| | - Ilya Kister
- Department of Neurology, Multiple Sclerosis Comprehensive Care Center, NYU Langone Medical Center, New York, NY, United States of America
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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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Negative impact of spinal epidural lipomatosis on the surgical outcome of posterior lumbar spinous-splitting decompression surgery: a multicenter retrospective study. Spine J 2019; 19:1977-1985. [PMID: 31254650 DOI: 10.1016/j.spinee.2019.06.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal epidural lipomatosis (SEL) results from excess lumbar epidural fat (EF) accumulation that compresses the cauda equina or nerve roots. Guidelines for the therapeutic management of SEL are not currently available. PURPOSE To elucidate the efficacy of lumbar decompression surgery in SEL. STUDY DESIGN Multicenter retrospective study. PATIENT SAMPLE A total of 288 consecutive patients who underwent posterior lumbar spinous-splitting decompression surgery for lumbar spinal canal stenosis and followed up greater than 2 years at participating institutions were retrospectively reviewed. OUTCOME MEASURES Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Roland-Morris Disability Questionnaire (RDQ). METHODS Participants were divided into two groups according to the ratio of EF to anteroposterior diameter of the spinal canal (EF/SC-L) at the spinal level with maximum dural tube compression. Patients with EF/SC-L of ≥0.6 and <0.6 were defined as those with SEL and non-SEL, respectively. We assessed whether surgical treatment was "effective" or "not effective" using the JOABPEQ based on the following: an increase of ≥20 points in the postoperative score compared with the preoperative score, or a preoperative score <90 with a postoperative score ≥90 points. We constructed a multiple Poisson regression model by adjusting for confounding factors, and determined estimated relative risk (RR) for "not effective" with surgical treatment using the JOABPEQ. Additionally, we selected age-, sex-, BMI-, and decompression levels-matched patients with non-SEL and compared the frequency of "not effective" between SEL patients (n=60) and non-SEL patients (n=60). RESULTS Analysis using the RDQ and JOABPEQ showed that the 1- and 2-year postoperative scores were significantly better than the preoperative scores in the both groups. Multivariable Poisson regression analysis demonstrated that SEL was significantly associated with "not effective" for decompression surgery in the 1-year postoperative outcomes of walking ability ([RR] 1.5, 95% confidence interval [CI] 1.0-2.2) and social life (RR 1.3, 95% CI 1.0-1.8) and the 2-year postoperative outcomes of walking ability (RR 1.6, 95% CI 1.2-2.3). Matching analysis showed that SEL was significantly associated with "not effective" with lumbar decompression surgery in the 2-year postoperative outcomes of walking ability (p=.02). CONCLUSIONS Patients with SEL exhibited significant improvements in surgical outcomes at 1 and 2 years postoperatively. However, compared with the non-SEL group, the efficacy of posterior lumbar spinous-splitting decompression surgery was worse in the SEL group, especially for walking ability. These results indicate that EF accumulation should be considered when planning treatment for patients with lumbar spinal canal stenosis and estimating the efficacy of lumbar decompression surgery.
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Chin J, Kviatkovsky B, Lomiguen C. Osteopathic Considerations for Peripheral Neuropathy Due to Concomitant Diffuse Idiopathic Skeletal Hyperostosis Syndrome and Lumbar Epidural Lipomatosis: Case Report. Interact J Med Res 2019; 8:e14607. [PMID: 31746769 PMCID: PMC6914272 DOI: 10.2196/14607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/16/2019] [Accepted: 08/30/2019] [Indexed: 12/12/2022] Open
Abstract
Background Diffuse idiopathic skeletal hyperostosis (DISH) syndrome and lumbar epidural lipomatosis are relatively asymptomatic neurological conditions, with findings often seen incidentally on radiological studies. Objective The aim of this paper is to present unique findings of concomitant, symptomatic DISH syndrome and lumbar epidural lipomatosis and to discuss the osteopathic diagnosis and treatment implications. Methods Concomitant, symptomatic variants are rare and present challenges to treatment and management, as seen with a 60-year-old African American woman who presented with worsening disequilibrium and new-onset bilateral fingertip numbness. Past medical history was significant for alcohol abuse disorder, hypertension, hyperlipidemia, and multiple episodes of self-resolving vertigo and lower extremity neuropathy. Results The patient was referred to the neurology department for stroke workup, which was negative. Osteopathic structural exam revealed thoracolumbar and sacral dysfunctions. Magnetic resonance imaging revealed findings consistent with thoracic DISH syndrome and lumbar epidural lipomatosis in the areas of somatic dysfunctions. Conclusions Due to minimal information on osteopathic manipulative treatment in rare neurological diseases, only gentle techniques of myofascial release, balanced ligamentous tension, and muscle energy were performed with resultant minimal improvement, thus highlighting the necessity for better guidelines and further research.
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Affiliation(s)
- Justin Chin
- Touro College of Osteopathic Medicine, New York, NY, United States
| | - Bina Kviatkovsky
- Staten Island University Hospital, Northwell Health, Staten Island, NY, United States
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Indentation of the lumbar thecal sac: Answer. J Clin Neurosci 2019. [DOI: 10.1016/j.jocn.2019.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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Abe T, Miyazaki M, Ishihara T, Kanezaki S, Notani N, Kataoka M, Tsumura H. Spinal epidural lipomatosis is associated with liver fat deposition and dysfunction. Clin Neurol Neurosurg 2019; 185:105480. [PMID: 31430628 DOI: 10.1016/j.clineuro.2019.105480] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/01/2019] [Accepted: 08/07/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVE This study examined the association of spinal epidural lipomatosis (SEL) with liver fat deposition and any other liver dysfunction, except steroid involvement. PATIENTS AND METHODS We analyzed 102 patients (62 men and 40 women; mean age 73.3 years) who underwent spinal magnetic resonance imaging (MRI), computed tomography (CT), and myelography for the diagnosis of lumbar spinal canal stenosis between January 2014 and June 2018. Additional data collected included height, weight, body mass index, blood test results (C-reactive protein, albumin, total bilirubin, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase [γ-GTP], total cholesterol, neutral fat, amylase, urea nitrogen, creatinine, estimated glomerular filtration rate, uric acid, platelets), the epidural fat-occupying ratio in each vertebra from L1/2 to L5/S1 on MRI, and liver CT values. RESULTS In 30 cases, the average occupying ratio of epidural fat was ≥40% (SEL), and in 45 cases, liver CT values were <40 HU (fatty liver). Correlation analysis between average occupying ratio of epidural fat and various measurements showed liver CT value (r = -0.574, P < 0.001), body weight (r = 0.304, P = 0.002), γ-GTP (r = 0.370, P = 0.01), and uric acid (r = 0.201, P = 0.04) to be independent explanatory factors. Multivariate analysis revealed that SEL was associated with liver CT value (odds ratio 0.774, 95% confidence interval [CI] 0.689-0.871) and body weight (odds ratio 1.063, 95% CI 1.016-1.135). CONCLUSION There was a strong correlation between epidural fat and liver fat deposits suggesting an association between SEL and systemic fat deposition.
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Affiliation(s)
- Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
| | - Toshinobu Ishihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Shozo Kanezaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Naoki Notani
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan
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Lipomatosis of spinal epidural space, peritoneum, and renal sinus: a rare complication of long-term steroid therapy in a child with nephrotic syndrome. Childs Nerv Syst 2019; 35:1401-1405. [PMID: 30941508 DOI: 10.1007/s00381-019-04141-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
Excessive visceral adipose tissue proliferation, resulting in diffuse lipomatosis, is a rare complication of long-term steroid therapy. A 10-year-old boy presented with severe radicular back pain with limitation of lower limb movements. He was diagnosed with steroid-resistant nephrotic syndrome and was on unregulated steroid therapy. Magnetic resonance imaging of the spine showed increased adipose tissue in the epidural space of the lumbo-sacral spine causing clumping of cauda equina nerve roots along with marked proliferation of fat in the renal sinus as well as peritoneum. He was started on pregabalin with tapering of steroids, following which there was a gradual decrease in pain and improvement of activity. Our patient had diffuse lipomatosis involving spinal epidural space, bilateral renal sinus, and peritoneum, secondary to steroid overuse. With the availability of advanced imaging techniques, the condition can be prevented by judicious and proper use of steroids with close follow-up for any untoward complications.
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Trungu S, Forcato S, Raco A. Spinal Epidural Lipomatosis: Weight Loss Cure. World Neurosurg 2019; 125:368-370. [DOI: 10.1016/j.wneu.2019.02.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
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Ishihara S, Fujita N, Azuma K, Michikawa T, Yagi M, Tsuji T, Takayama M, Matsumoto H, Nakamura M, Matsumoto M, Watanabe K. Spinal epidural lipomatosis is a previously unrecognized manifestation of metabolic syndrome. Spine J 2019; 19:493-500. [PMID: 30077045 DOI: 10.1016/j.spinee.2018.07.022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 06/29/2018] [Accepted: 07/26/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spinal epidural lipomatosis (SEL) is a condition in which excess lumbar epidural fat (EF) deposition often leads to compression of the cauda equina or nerve root. Although SEL is often observed in obese adults, no systematic research investigating the potential association between SEL and metabolic syndrome has been conducted. PURPOSE To elucidate potential association between SEL and metabolic syndrome. STUDY DESIGN An observational study used data of a medical checkup. PATIENT SAMPLE We retrospectively reviewed data from consecutive subjects undergoing medical checkups. A total of 324 subjects (174 men and 150 women) were enrolled in this study. OUTCOME MEASURES The correlation of EF accumulation with demographic data and metabolic-related factors was evaluated. METHODS The degree of EF accumulation was evaluated based on the axial views of lumbar magnetic resonance imaging. Visceral and subcutaneous fat areas were measured at the navel level using abdominal computed tomography. Metabolic syndrome was diagnosed according to the criteria of the Japanese Society of Internal Medicine. The correlation of SEL with metabolic syndrome and metabolic-related conditions was statistically evaluated. RESULTS The degree of EF accumulation demonstrated a significant correlation to body mass index, abdominal circumference, and visceral fat area. However, age, body fat percentage, and subcutaneous fat area showed no correlation with the degree of EF accumulation. Logistic regression analysis revealed that metabolic syndrome (odds ratio [OR]=3.8, 95% confidence interval [CI]=1.5-9.6) was significantly associated with SEL. Among the diagnostic criteria for metabolic syndrome, visceral fat area ≥100 cm2 (OR=4.8, 95% CI=1.5-15.3) and hypertension (OR=3.5, 95% CI=1.1-11.8) were observed to be independently associated with SEL. CONCLUSION This is the first study to demonstrate that metabolic syndrome is associated with SEL in a relatively large, unbiased population. Our data suggest that metabolic-related conditions are potentially related to EF deposition and that SEL could be a previously unrecognized manifestation of metabolic syndrome.
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Affiliation(s)
- Shinichi Ishihara
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan; Department of Orthopaedic Surgery, International University of Health and Welfare (IUHW), Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo 108-8329, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan.
| | - Koichiro Azuma
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Takehiro Michikawa
- Environmental Epidemiology Section, Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki 305-8506, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
| | - Takashi Tsuji
- Department of Orthopaedic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Michiyo Takayama
- Center for Preventive Medicine, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hideo Matsumoto
- Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
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Valcarenghi J, Bath O, Boghal H, Ruelle M, Lambert J. Benefits of bariatric surgery on spinal epidural lipomatosis: case report and literature review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1437-1440. [DOI: 10.1007/s00590-018-2206-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/13/2018] [Indexed: 11/30/2022]
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Management of idiopathic spinal epidural lipomatosis: a case report and review of the literature. Childs Nerv Syst 2018; 34:757-763. [PMID: 29273822 DOI: 10.1007/s00381-017-3706-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Spinal epidural lipomatosis (SEL) is a rare pathologic growth of histologically normal unencapsulated adipose tissue in the epidural space. Although rare, SEL can compress the spinal cord or nerve roots causing myelopathy or radiculopathy. While SEL has been associated with long-term exposure to endogenous or exogenous steroids and obesity, idiopathic forms of SEL are much rarer. CASE REPORT In this report, we present the first case of SEL isolated to the cervical region compressing the spinal cord in a healthy, non-obese, preadolescent patient. CONCLUSION Idiopathic SEL in the pediatric population is a rare entity. This is the first case of epidural lipomatosis isolated to the cervical region in an adult or child patient. In refractory, symptomatic cases of idiopathic SEL, surgical decompression is often required.
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Thioub M, Mbaye M, Cissé ME, Ndoye N, Thiam AB, Badiane SB. [Narrow lumbar channel due to epidural lipomatosis: case report and literature review]. Pan Afr Med J 2018; 28:187. [PMID: 29599885 PMCID: PMC5871247 DOI: 10.11604/pamj.2017.28.187.13233] [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: 07/02/2017] [Accepted: 10/05/2017] [Indexed: 11/11/2022] Open
Abstract
La lipomatose épidurale est une pathologie caractérisée par une l'accumulation anormale de graisse non encapsulée dans l'espace épidural. Bien que rare, elle est une cause possible de lombosciatique ou de canal lombaire étroit. Elle est souvent associée à des facteurs favorisants tels qu'une corticothérapie prolongée, ou une obésité. Nous rapportons une observation d'un patient qui a présenté des lombosciatalgies invalidantes et dont l'exploration radiologique a confirmé une lipomatose épidurale compressive. L'évolution a été favorable après décompression chirurgicale.
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Affiliation(s)
- Mbaye Thioub
- Université Cheikh Anta Diop de Dakar, Centre Hospitalier National Universitaire de FANN, Sénégal
| | - Maguette Mbaye
- Université Cheikh Anta Diop de Dakar, Centre Hospitalier National Universitaire de FANN, Sénégal
| | - Mohamed Elhassimi Cissé
- Université Cheikh Anta Diop de Dakar, Centre Hospitalier National Universitaire de FANN, Sénégal
| | - Ndaraw Ndoye
- Université Cheikh Anta Diop de Dakar, Centre Hospitalier National Universitaire de FANN, Sénégal
| | - Alioune Badara Thiam
- Université Cheikh Anta Diop de Dakar, Centre Hospitalier National Universitaire de FANN, Sénégal
| | - Seydou Boubakar Badiane
- Université Cheikh Anta Diop de Dakar, Centre Hospitalier National Universitaire de FANN, Sénégal
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Yasuda T, Suzuki K, Kawaguchi Y, Seki S, Makino H, Watanabe K, Hori T, Yamagami T, Kanamori M, Kimura T. Clinical and imaging characteristics in patients undergoing surgery for lumbar epidural lipomatosis. BMC Musculoskelet Disord 2018; 19:66. [PMID: 29490659 PMCID: PMC5831840 DOI: 10.1186/s12891-018-1988-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/23/2018] [Indexed: 12/13/2022] Open
Abstract
Background Lumbar epidural lipomatosis (LEL) is characterized by abnormal accumulation of unencapsulated adipose tissue in the spinal epidural space. Such accumulation compresses the dural sac and nerve roots, and results in various neurological findings. However, the pathophysiology of LEL remains unclear. This study examined the associations between imaging and clinical findings in detail, and investigated the mechanisms underlying symptom onset by measuring intraoperative epidural pressures in LEL. Methods Sixteen patients (all men; mean age, 68.8 years) were enrolled between 2011 and 2015. Mean body mass index was 26.5 kg/m2. Four cases were steroid-induced, and the remaining 12 cases were idiopathic. All patients presented with neurological deficits in the lower extremities. Cauda equina syndrome (CES) alone was seen in 8 patients, radiculopathy alone in 4, and both radiculopathy and CES (mixed CES) in 4. All patients subsequently underwent laminectomy with epidural lipomatosis resection and were followed-up for more than 1 year. We investigated the clinical course and imaging and measured epidural pressures during surgery. Results Subjective symptoms improved within 1 week after surgery. Mean Japanese Orthopaedic Association (JOA) score was 15.2 ± 2.8 before surgery, improving to 25.4 ± 2.5 at 1 year after surgery. On magnetic resonance imaging, all lipomatosis lesions included the L4–5 level. On preoperative computed tomography, saucerization of the laminae was not observed in radiculopathy cases, whereas saucerization of the posterior vertebral body was observed in all radiculopathy or mixed CES cases. Intraoperative epidural pressures were significantly higher than preoperative subarachnoid pressures. The results suggest that high epidural pressure resulting from the proliferation of adipose tissue leads to saucerization of the lumbar spine and subsequent symptoms. Conclusions Clinical courses were satisfactory after laminectomy. In LEL, epidural pressure increases and symptoms develop through the abnormal proliferation of adipose tissue. Higher epidural pressures induce saucerization of the laminae and/or posterior vertebral body. Furthermore, the direction of proliferative adipose tissue (i.e., site of saucerization) might be related to the types of neurological symptoms.
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Affiliation(s)
- Taketoshi Yasuda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
| | - Kayo Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Kenta Watanabe
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Takeshi Hori
- Department of Orthopaedic Surgery, Nippon Koukan Hospital, 1-2-1 Kokandori, Kawasaki, Kanagawa, 210-0852, Japan
| | - Tohru Yamagami
- Department of Orthopaedic Surgery, Itoigawa General Hospital, 457, Takegahana, Itoigawa, Niigata, 941-8502, Japan
| | - Masahiko Kanamori
- Department of Human Science 1, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
| | - Tomoatsu Kimura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan
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Malone JB, Bevan PJ, Lewis TJ, Nelson AD, Blaty DE, Kahan ME. Incidence of spinal epidural lipomatosis in patients with spinal stenosis. J Orthop 2017; 15:36-39. [PMID: 29203971 DOI: 10.1016/j.jor.2017.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022] Open
Abstract
Inroduction Spinal Epidural Lipomatosis (SEL) is believed to be a rare disorder. The incidence and prevalence of clinically symptomatic SEL in patients with spinal stenosis has never been reported in the literature. Our study aims to determine the prevalence, incidence, and associated risk factors of SEL in patients with the diagnosis of spinal stenosis. Methods This is a retrospective study. We reviewed the charts of 831 patients with the diagnosis of spinal stenosis over a 30 month period. All patients had spinal MRIs. Grading of SEL was performed using the Borré method. Results 52 patients (21 female and 31 male) had symptomatic moderate and severe SEL. We found a prevalence of 6.26% and an annual incidence of 2.5%. SEL was most commonly seen at L5-S1 level. 27% had received corticosteroids. All SEL patients were overweight and 79% were obese. Conclusions SEL is not uncommon in patients with spinal stenosis. SEL should be considered as a possible diagnosis in those with symptoms of spinal stenosis especially in those with associated risk factors.
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Affiliation(s)
- Jason Bradley Malone
- Good Samaritan Regional Medical Center, 3600 NW Samaritan Dr., Corvallis, OR 97330 USA.,Phoenix Children's Hospital, 1919 E. Thomas Rd, Phoenix, AZ 85016, USA
| | - Patrick Jon Bevan
- Good Samaritan Regional Medical Center, 3600 NW Samaritan Dr., Corvallis, OR 97330 USA
| | - Todd Jay Lewis
- Good Samaritan Regional Medical Center, 3600 NW Samaritan Dr., Corvallis, OR 97330 USA
| | - Andrew David Nelson
- Good Samaritan Regional Medical Center, 3600 NW Samaritan Dr., Corvallis, OR 97330 USA
| | - Doug Edward Blaty
- Good Samaritan Regional Medical Center, 3600 NW Samaritan Dr., Corvallis, OR 97330 USA
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Spinal cord. HANDBOOK OF CLINICAL NEUROLOGY 2017. [PMID: 28987187 DOI: 10.1016/b978-0-12-802395-2.00029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
We first present a brief historic review of developments in the understanding of spinal cord clinical neuroanatomy and neurophysiology over the past 200 years. We then discuss the technical aspects that apply to the examination of the human spinal cord giving details on the interrelations between the spinal cord and the overlying structures, including the meninges and vertebrae. The subsequent discussion focuses on diseases of the spinal cord. Diseases that affect the spinal cord are vascular disease, diseases of spinal column, trauma, developmental abnormalities, central nervous system degenerative disease, inflammatory disease, metabolic and nutritional myelopathies, and tumors. We summarize our knowledge regarding general reactions of spinal cord tissue to disease, in particular Wallerian degeneration of descending/ascending tracts and axonal reaction. Two categories of disease will be covered in depth: vascular disease of the spinal cord, including a review of normal vascular anatomy, and diseases of the vertebral column that can affect the cord secondarily.
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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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A proposed link between spinal epidural lipomatosis, prostate cancer and androgen deprivation therapy. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817717907] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present a patient with prostate cancer with vertebral metastases who developed spastic paraparesis secondary to spinal epidural lipomatosis (SEL) after receiving androgen deprivation therapy (ADT). We propose a link between ADT, metastatic prostate cancer and SEL.
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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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Potential Involvement of Obesity-Associated Chronic Inflammation in the Pathogenesis of Idiopathic Spinal Epidural Lipomatosis. Spine (Phila Pa 1976) 2016; 41:E1402-E1407. [PMID: 27105459 DOI: 10.1097/brs.0000000000001646] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Multicenter case-control study. OBJECTIVE To characterize the pathogenesis of idiopathic spinal epidural lipomatosis (SEL). SUMMARY OF BACKGROUND DATA SEL is often associated with the history of steroid use or endocrine disorders; however, the pathogenesis of idiopathic SEL remains poorly understood. METHODS Sixteen patients who underwent lumbar decompression surgery due to severe idiopathic SEL were included in the study (L group, 15 men and 1 woman; mean age, 71.5 yrs). Fifteen patients without SEL, who underwent decompression surgery for lumbar canal stenosis, were selected as controls (C group, 14 men and 1 woman; mean age, 70.3 yrs). The following parameters were analyzed in these two groups: body mass index (BMI), medical history, histology, the size of adipocytes in the epidural fat (EF) tissues, and the expression level of the transcripts for adiponectin, leptin, tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, and IL-8. RESULTS The mean BMI of the L group was significantly higher than that of the C group (29.1 vs. 25.2 kg/m, P = 0.006), and there was a significant correlation between BMI and the width of EF in both groups. The average adipocyte size in the EF was significantly larger in the L group than in the C group (2846.8 vs. 1699.0 μm, P = 0.017). Furthermore, the expression levels of the transcripts for TNF-α and IL-1β in the L group were significantly higher than those in the C group [2.59-fold increase (P = 0.023) and 2.60-fold increase (P = 0.015), respectively]. CONCLUSION Our data suggest that the pathogenesis of idiopathic SEL is associated with obesity. In addition, the increased expression of two major inflammatory cytokines in the EF in the L group may indicate that SEL is causally related to chronic inflammation. LEVEL OF EVIDENCE 3.
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Yildirim B, Puvanesarajah V, An HS, Novicoff WM, Jain A, Shen FH, Hassanzadeh H. Lumbosacral Epidural Lipomatosis: A Retrospective Matched Case-Control Database Study. World Neurosurg 2016; 96:209-214. [DOI: 10.1016/j.wneu.2016.08.125] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022]
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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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[Spinal epidural lipomatosis as a rare side effect in steroid-dependent Jo-1 antibody syndrome]. Z Rheumatol 2016; 75:939-942. [PMID: 27581001 DOI: 10.1007/s00393-016-0173-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Spinal epidural lipomatosis (SEL) of the thoracic and lumbar spine is a rare entity, which leads to compression of the spinal canal. The exact pathogenesis is still unknown. It most commonly occurs in patients with long-term exogenous or endogenous glucocorticoid excess or morbid obesity but there are also idiopathic forms. The symptoms depend on the severity of the SEL and can manifest as clinically asymptomatic, non-specific back pain, radiculopathy up to spinal cord compression. The diagnosis is usually achieved by magnetic resonance imaging (MRI) of the affected spinal segments. The treatment varies between discontinuation of glucocorticoids, weight reduction up to multisegmental decompressive laminectomy. The following case report presents the findings of SEL in a patient with steroid-dependent Jo-1 antibody syndrome and provides a current literature review on this rare disease.
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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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Yamanaka D, Kawano T, Shigematsu-Locatelli M, Nishigaki A, Kitamura S, Aoyama B, Tateiwa H, Kitaoka N, Yokoyama M. Failure of lumbar puncture in a patient with spinal epidural lipomatosis: a case report. JA Clin Rep 2016; 2:14. [PMID: 29497669 PMCID: PMC5818763 DOI: 10.1186/s40981-016-0040-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/29/2016] [Indexed: 11/10/2022] Open
Abstract
We report a case of difficult lumbar puncture due to the inability to obtain adequate cerebrospinal fluid (CSF) in a patient later diagnosed with spinal epidural lipomatosis (SEL). A 76-year-old man with a body mass index (BMI) of 24.1 kg/m2 was scheduled for transurethral resection of a bladder tumor for superficial bladder cancer under spinal anesthesia. The patient had a 3-year history of inhaled steroid use for the management of chronic obstructive pulmonary disease. After placing the patient in the right lateral position, a lumbar puncture was performed via the median approach. However, CSF could not be tapped adequately despite repeated attempts at lumbar puncture, so general anesthetic was administered instead. Subsequently, both anesthesia and surgery proceeded uneventfully. On the first postoperative day, the patient developed mild postdural puncture headache (PDPH), which was treated conservatively. No postoperative neurological complications related to spinal anesthesia were observed. Approximately 2 months after discharge, the patient reported progressive lower back pain and was diagnosed with SEL by magnetic resonance imaging (MRI). A lumbar laminectomy and removal of excessive adipose tissue was performed. After surgery, the patient's symptoms resolved. The pathogenesis of SEL involves excess fat tissue deposition in the spinal canal, which can lead to obliteration of the spinal subarachnoid space. Therefore, in this patient, the SEL was thought to have caused the inability to obtain adequate CSF during lumbar puncture, and was associated with difficult spinal anesthesia.
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Affiliation(s)
- Daiki Yamanaka
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Takashi Kawano
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Marie Shigematsu-Locatelli
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Atsushi Nishigaki
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Sonoe Kitamura
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Bun Aoyama
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Hiroki Tateiwa
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Noriko Kitaoka
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Masataka Yokoyama
- Department of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
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Kim YS, Ju CI, Kim SW, Kim HS. Cauda Equina Syndrome Caused by Idiopathic Epidural Lipomatosis. KOREAN JOURNAL OF SPINE 2015; 12:272-4. [PMID: 26834816 PMCID: PMC4731563 DOI: 10.14245/kjs.2015.12.4.272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/11/2015] [Accepted: 09/21/2015] [Indexed: 11/19/2022]
Abstract
Spinal epidural lipomatosis (SEL) is a rare condition that presents as a back pain with progressive neurologic symptoms. Most affected patients are obese and receiving steroid therapy, or have an endocrinopathies. We report a rare case of cauda equina syndrome caused by SEL in a non-obese healthy young man without any evident traumatic episode. A healthy 19-year-old man, who had experienced lower back pain for two months, visited our emergency room because of the sudden development of motor weakness and voiding difficulty. Lumbar magnetic resonance image revealed extradural fat compressing the cauda equina. Urgent decompression via posterior laminectomy and excision of excess epidural fat resulted in an immediate symptom improvement.
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Affiliation(s)
- Yun Seong Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Chang Il Ju
- Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, Chosun University College of Medicine, Gwangju, Korea
| | - Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Hospital, Suwon, Korea
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42
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Loriaux DB, Adogwa O, Gottfried ON. Radiculopathy in the setting of lumbar nerve root compression due to an extradural intraforaminal lipoma: a report of 3 cases. J Neurosurg Spine 2015; 23:55-8. [DOI: 10.3171/2014.11.spine14693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A true adult spinal lipoma is an exceedingly rare cause of lumbar compression neuropathy. Only 5 cases of true extradural intraforaminal lipomas have been documented in the medical literature. The diagnostic criteria and treatment guidelines for this specific lipoma have yet to be established. This report features 3 histologically confirmed cases of extradural intraforaminal spinal lipomas that recently presented to the authors’ practice. In addition, the literature was surveyed to include the 5 previously reported cases of true adult extradural intraforaminal spinal lipomas. The consistency in presentation, response to surgical intervention, and postoperative recovery in these 8 cases supports surgical intervention at the time of diagnosis. The authors’ findings support elevated clinical suspicion, efficient diagnosis based on MRI, and early surgical intervention for this rare pathological entity. All cases presented in this report were symptomatic and occurred in the absence of other significant pathologies such as general spinal epidural lipomatosis, intradural lesions, tethering, or severe degenerative stenosis or herniated discs. The clinical, neuroradiological, and histological findings characteristic of a true adult extradural intraforaminal lipoma are emphasized to differentiate this lesion from the more common etiologies for lumbar compression neuropathy. Heightened awareness and clinical suspicion for the focal, foraminal spinal lipoma as a cause of radiculopathy symptoms will enable more efficient diagnosis and treatment.
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43
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Praver M, Kennedy BC, Ellis JA, D'Amico R, Mandigo CE. Severity of presentation is associated with time to recovery in spinal epidural lipomatosis. J Clin Neurosci 2015; 22:1244-9. [PMID: 26067546 DOI: 10.1016/j.jocn.2015.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 03/14/2015] [Indexed: 11/16/2022]
Abstract
We present a patient with prednisone-induced spinal epidural lipomatosis (SEL) and relatively acute neurologic deterioration followed by rapid recovery after surgical decompression. SEL is a rare disease characterized by hypertrophy of epidural fat, most commonly associated with exogenous steroid use. To our knowledge, an analysis of the dynamics of steroid dose related to time to onset has never been performed, or of patient presentation features with respect to patient outcome. We retrospectively reviewed the literature for English language series and case reports of SEL associated with prednisone use from 1975-2013. Data were compiled for 41 patients regarding the prescribed dose of prednisone and length of treatment, as well as the severity of symptoms on the Ranawat scale, time to onset, time to recovery, and degree of recovery of neurological symptoms. Fisher's exact test and analysis of variance were used for comparing proportions, and p values <0.05 were considered statistically significant. We found that the mean cumulative dose of prednisone trended towards an association with a lack of recovery (p=0.06) and may be related to rate of recovery. Prescribed prednisone dose varied inversely with the time before onset of neurological symptoms, but failed to reach statistical significance. Higher severity of presenting symptoms on the Ranawat scale were found to be associated with a higher likelihood of delayed recovery (p=0.035). Patients with symptoms lower on the Ranawat scale more frequently experienced complete neurologic recovery, though this did not reach significance. The acuity of neurological deterioration was not related to the time to recovery or ultimate degree of recovery. Severity of presentation on the Ranawat scale is associated with rate of recovery and may be related to degree of recovery in SEL patients. Cumulative dose of prednisone may be related to degree and rate of recovery. Prescribed dose of prednisone may be related to time to onset of neurological symptoms. Acuity of neurological deterioration is not related to rate or degree of recovery.
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Affiliation(s)
- Moshe Praver
- Department of Neurological Surgery, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA.
| | - Benjamin C Kennedy
- Department of Neurological Surgery, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
| | - Jason A Ellis
- Department of Neurological Surgery, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
| | - Randy D'Amico
- Department of Neurological Surgery, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
| | - Christopher E Mandigo
- Department of Neurological Surgery, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA
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44
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Dawes B, Lo J, Byrne ST, Gonzalvo A, Wilde P. Symptomatic concurrent spinal epidural lipomatosis and spinal pathology. ANZ J Surg 2015; 87:E98-E99. [PMID: 25707460 DOI: 10.1111/ans.13000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bryden Dawes
- Department of Neurosurgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathon Lo
- Department of Neurosurgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen T Byrne
- Department of Neurosurgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Augusto Gonzalvo
- Department of Neurosurgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Wilde
- Department of Orthopaedic Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia
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Noh E. An unusual complication of morbid obesity: epidural lipomatosis. Am J Emerg Med 2015; 33:742.e3-4. [PMID: 25618765 DOI: 10.1016/j.ajem.2014.11.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/22/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- El Noh
- Palms West Hospital, Loxahatchee, FL 33470.
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46
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Soldatos T, Chalian M, Thawait S, Belzberg AJ, Eng J, Carrino JA, Chhabra A. Spectrum of magnetic resonance imaging findings in congenital lumbar spinal stenosis. World J Clin Cases 2014; 2:883-887. [PMID: 25516864 PMCID: PMC4266837 DOI: 10.12998/wjcc.v2.i12.883] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 10/30/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate whether congenital lumbar spinal stenosis (CLSS) is associated with a specific degenerative changes of the lumbar spine.
METHODS: The lumbar spine magnetic resonance imaging studies of 52 subjects with CLSS and 48 control subjects were retrospectively evaluated. In each examination, the five lumbar levels were assessed for the presence or absence of circumferential or shallow annular bulges, annular tears, anterior or posterior disc herniations, epidural lipomatosis, Schmorl’s nodes, spondylolisthesis, pars defects, and stress reactions of the posterior vertebral elements.
RESULTS: Compared to control individuals, subjects with CLSS exhibited increased incidence of circumferential and shallow annular bulges, annular tears, disc herniations and spondylolisthesis (P < 0.05).
CONCLUSION: CLSS is associated with increased incidence of degenerative changes in specific osseous and soft-tissue elements of the lumbar spine.
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47
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Epidural lipomatosis: A possible cause of back pain. Ann Phys Rehabil Med 2014; 57:734-7. [PMID: 25193775 DOI: 10.1016/j.rehab.2014.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/01/2014] [Accepted: 08/01/2014] [Indexed: 11/18/2022]
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48
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Jaimes R, Rocco AG. Multiple epidural steroid injections and body mass index linked with occurrence of epidural lipomatosis: a case series. BMC Anesthesiol 2014; 14:70. [PMID: 25183952 PMCID: PMC4145583 DOI: 10.1186/1471-2253-14-70] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 08/05/2014] [Indexed: 12/17/2022] Open
Abstract
Background Epidural lipomatosis (EL) is an increase of adipose tissue, normally occurring in the epidural space, sufficient to distort the thecal sac and compress neural elements. There is a lack of knowledge of risk factors, impact on patient’s symptoms, and its possible association with epidural steroid injections. Methods History, physical examination, patient chart, and MRI were analyzed from 856 outpatients referred for epidural steroid injections. Seventy patients with signs of EL on MRI comprised the study group. Thirty-four randomly selected patients comprised the control group. The severity of EL was determined by the MRI assessment. The impact of EL was determined by the patient’s history and physical examination. Logistic regression was used to correlate the probability of developing EL with BMI and epidural steroid injections. Results EL was centered at L5 and S1 segments. The average BMI for patients with EL was significantly greater than that of control group (36.0 ± 0.9 vs. 29.2 ± 0.9, p <0.01). The probability of developing EL with increasing BMI was linear up to the BMI of 35 after which it plateaued. Triglycerides were significantly higher for the EL group as compared to controls (250 ± 30 vs. 186 ± 21 mg/dL p < 0.01). The odds of having EL were 60% after two epidural steroid injections, 90% after three epidural steroid injections and approached 100% with further injections, independent of BMI. Other risk factors considered included alcohol abuse, use of protease inhibitors, levels of stress, hypothyroidism and genetic predisposition. However there were insufficient quantities to determine statistical significance with a degree of confidence. The impact of EL on patient’s symptoms correlated with EL severity with Spearman correlation coefficient of 0.73 at p < 0.01 significance level. Conclusions The BMI and triglycerides levels were found to be significantly elevated for the EL group, pointing to an increased risk of EL occurrence in progressively more obese US population. The data also revealed a strong correlation between the number of subsequent epidural steroid injections and EL occurrence calling for caution with the use of corticosteroids.
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Affiliation(s)
- Rafael Jaimes
- The George Washington University, 2300 I St NW Ross Hall Room 456, Washington D.C 20037, USA
| | - Angelo G Rocco
- Department of Orthopedics, Harvard Vanguard Medical Associates, 133 Brookline Ave, Boston, MA 02215, USA
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49
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Yoo JC, Choi JJ, Lee DW, Lee SP. Spinal epidural lipomatosis in korean. J Korean Neurosurg Soc 2014; 55:365-9. [PMID: 25237435 PMCID: PMC4166335 DOI: 10.3340/jkns.2014.55.6.365] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/09/2014] [Accepted: 06/11/2014] [Indexed: 11/27/2022] Open
Abstract
Spinal epidural lipomatosis (SEL) is a rare disorder, regarded in literature as a consequence of administration of exogenous steroids, associated with a variety of systemic diseases, endocrinopathies and the Cushing's syndrome. Occasionally, SEL may occur in patients not exposed to steroids or suffering from endocrinopathies, namely, idiopathic SEL. Thus far, case studies of SEL among Korean have been published rather sporadically. We reviewed the clinical features of SEL cases, among Koreans with journal review, including this report of three operated cases. According to this study, there were some differences between Korean and western cases. Koreans had higher incidences of idiopathic SEL, predominant involvement in the lumbar segments, very few thoracic involvement and lower MBI, as opposed to westerners.
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Affiliation(s)
- Je Chul Yoo
- Department of Neurosurgery, Cheju Halla Hospital, Jeju, Korea
| | - Jeong Jae Choi
- Department of Neurosurgery, Cheju Halla Hospital, Jeju, Korea
| | - Dong Woo Lee
- Department of Neurosurgery, Cheju Halla Hospital, Jeju, Korea
| | - Sang Pyung Lee
- Department of Neurosurgery, Cheju Halla Hospital, Jeju, Korea
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50
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Sugaya H, Tanaka T, Ogawa T, Mishima H. Spinal epidural lipomatosis in lumbar magnetic resonance imaging scans. Orthopedics 2014; 37:e362-6. [PMID: 24762841 DOI: 10.3928/01477447-20140401-57] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 11/08/2013] [Indexed: 02/03/2023]
Abstract
The goal of this study was to quantify the frequency of advanced spinal epidural lipomatosis (SEL) detected on lumbar magnetic resonance imaging (MRI) scans performed at the authors' hospital and to compare the frequency, cause, and progression of SEL in these cases with that reported in the literature. The total number of MRI examinations of the lumbar spine performed at this hospital over 45 months was 1498 (705 men and 793 women; mean age, 60.3 years). After the MRI data were reduced (T1- and T2-weighted sagittal and axial images) on the basis of the exclusion criteria, the anterior and posterior diameters of the dural sac and spinal canal were measured, as well as the thickness of the epidural fat. On the basis of these parameters, the severity of SEL was classified as grade 0 to grade III. Five cases of grade III SEL were diagnosed. The frequency of grade III SEL noted in this study was 0.33% (5/1498). Obesity (body mass index greater than 27.5) was noted in 3 cases, and the use of exogenous corticosteroids was noted in 3 cases. Exogenous steroid usage associated with advanced SEL in this study was greater than that reported in the literature. Most symptoms of SEL progress slowly, and early diagnosis allows for a dose reduction of the prescribed steroids. Thus, lumbar MRI examinations should be conducted aggressively in patients with exogenous steroid use and presenting with low back pain or buttock pain.
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