1
|
张 乐, 徐 玉, 樊 攀, 李 熹, 王 佳, 陶 禹, 李 骁, 王 运. [Clinical research progress of spinal epidural lipomatosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1284-1291. [PMID: 37848326 PMCID: PMC10581873 DOI: 10.7507/1002-1892.202305071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/29/2023] [Indexed: 10/19/2023]
Abstract
Objective To review the clinical research progress of spinal epidural lipomatosis (SEL). Methods The clinical studies on SEL at home and abroad in recent years were extensively reviewed, and the pathogenesis, clinical and imaging manifestations, and treatment status of SEL were summarized and analyzed. Results SEL is a disease characterized by compression of the spinal cord and nerve roots due to abnormal accumulation of epidural adipose tissue in the spinal canal. Its prevalence and diagnosis rate are low and the pathogenesis is not fully understood. MRI is the most sensitive and specific diagnostic test for SEL. Surgical decompression and removal of excess adipose tissue are the only options for patients with acute SEL or those who have failed conservative management, and conservative management should be considered for other patients. Conclusion SEL is a rare disease and related research still needs to be improved. In the future, high-quality, multi-center and large-sample studies will be of great significance for evaluating the choice of treatment methods and effectiveness of SEL patients.
Collapse
Affiliation(s)
- 乐乐 张
- 东南大学附属中大医院脊柱外科中心(南京 210009)Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)Medical School, Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 玉柱 徐
- 东南大学附属中大医院脊柱外科中心(南京 210009)Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)Medical School, Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 攀 樊
- 东南大学附属中大医院脊柱外科中心(南京 210009)Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)Medical School, Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 熹 李
- 东南大学附属中大医院脊柱外科中心(南京 210009)Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)Medical School, Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 佳东 王
- 东南大学附属中大医院脊柱外科中心(南京 210009)Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)Medical School, Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 禹澳 陶
- 东南大学附属中大医院脊柱外科中心(南京 210009)Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)Medical School, Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 骁龙 李
- 东南大学附属中大医院脊柱外科中心(南京 210009)Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)Medical School, Southeast University, Nanjing Jiangsu, 210009, P. R. China
| | - 运涛 王
- 东南大学附属中大医院脊柱外科中心(南京 210009)Department of Spine Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing Jiangsu, 210009, P. R. China
- 东南大学医学院(南京 210009)Medical School, Southeast University, Nanjing Jiangsu, 210009, P. R. China
| |
Collapse
|
2
|
Neal MT, Patra DP, Lyons MK. Surgical management of thoracic myelopathy from long-segment epidural lipomatosis with skip hemilaminotomies: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21595. [PMID: 35855484 PMCID: PMC9281437 DOI: 10.3171/case21595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thoracic spinal epidural lipomatosis (SEL) involves the pathological overgrowth of histologically normal, unencapsulated adipose tissue that can compress the spinal cord and cause myelopathy. SEL has been associated with multiple medical conditions, including Scheuermann kyphosis (SK). Optimal treatment strategies for SEL, especially in the setting of a sagittal spinal deformity, remain unclear. OBSERVATIONS In this report, the authors discussed surgical management of a patient with thoracic SEL and SK using skip hemilaminotomies for resection of the epidural adipose tissue. To the authors’ knowledge, only one other report described a similar surgical technique in a patient who did not have a spinal deformity. LESSONS When conservative efforts fail, thoracic SEL may require surgical treatment. Surgical planning must account for co-medical conditions such as SK. The described approach involving skip laminotomies, which minimizes spine destabilization, is a viable option to treat SEL spanning multiple spinal segments. Prognosis after surgical treatment varies and is impacted by multiple factors, including severity of preoperative neurological deficits.
Collapse
Affiliation(s)
| | - Devi P. Patra
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona
| | - Mark K. Lyons
- Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|