Top

European Spine Journal

Published in:

01-07-2018 | Original Article

Lumbar epidural lipomatosis is associated with visceral fat and metabolic disorders

Authors: Shingo Morishita, Yoshiyasu Arai, Toshitaka Yoshii, Kenichiro Sakai, Takashi Hirai, Atsushi Okawa

Published in: European Spine Journal | Issue 7/2018

Abstract

Purpose

Lumbar spinal epidural lipomatosis (LEL) is a condition characterized by excessive deposition of epidural fat in the spinal canal. Metabolic abnormalities may be associated with LEL, but few validated reports exist. Thus, we investigated the association between LEL and metabolic disorders in this study.

Methods

A total of 218 patients who had neurological symptoms due to neural compression in the lumbar spinal canal were examined by magnetic resonance imaging (MRI), abdominal computed tomography (CT) scans and blood tests. We evaluated the epidural fat, dural sac and spinal canal areas using MRI, and the visceral fat and subcutaneous fat areas using abdominal CT. We compared the patients’ demographics and the radiological parameters between the LEL and non-LEL patients.

Results

There were 58 LEL patients and 160 non-LEL patients. The LEL group included more men than women. In the MRI measurement, the dural sac area was similar between the LEL and non-LEL patients; however, the epidural fat/spinal canal ratio was much greater in the LEL group. In the LEL patients, factors associated with metabolic disorders, such as visceral fat area, uric acid (UA) and insulin levels, were significantly greater, compared to the non-LEL patients. In the logistic regression analysis, UA and visceral fat area were the independent explanatory factors in the pathogenesis of LEL.

Conclusions

LEL patients had significantly more visceral fat and increased levels of insulin, UA and ferritin, which are closely related with metabolic disorders. This study indicates that the increased epidural fat in the spinal canal seen in the LEL patients is associated with metabolic syndrome.

Graphical abstract

These slides can be retrieved under Electronic Supplementary material.

Available only for authorised users

Ishikawa Y, Shimada Y, Miyakoshi N, Suzuki T, Hongo M, Kasukawa Y, Okada K, Itoi E (2006) Decompression of idiopathic lumbar epidural lipomatosis: diagnostic magnetic resonance imaging evaluation and review of the literature. J Neurosurg Spine 4:24–30. https://doi.org/10.3171/spi.2006.4.1.24 CrossRefPubMed

Ferlic PW, Mannion AF, Jeszenszky D, Porchet F, Fekete TF, Kleinstück F, Haschtmann D (2016) Patient-reported outcome of surgical treatment for lumbar spinal epidural lipomatosis. Spine J 16:1333–1341. https://doi.org/10.1016/j.spinee.2016.06.022 CrossRefPubMed

Lee M, Lekias J, Gubbay SS, Hurst PE (1975) Spinal cord compression by extradural fat after renal transplantation. Med J Aust 1:201–203PubMed

Fogel GR, Cunningham PY, Esses SI (2005) Spinal epidural lipomatosis: case reports, literature review and meta-analysis. Spine J 5:202–211CrossRefPubMed

Badami JP, Hinck VC (1982) Symptomatic deposition of epidural fat in a morbidly obese woman. AJNR Am J Neuroradiol 3:664–665PubMed

Koch CA, Doppman JL, Patronas NJ, Nieman LK, Chrousos GP (2000) Do glucocorticoids cause spinal epidural lipomatosis? When endocrinology and spinal surgery meet. Trends Endocrinol Metab 11:86–90CrossRefPubMed

Fujita N, Hosogane N, Hikata T, Iwanami A, Watanabe K, Shiono Y, Okada E, Ishikawa M, Tsuji T, Shimoda M, Horiuchi K, Nakamura M, Matsumoto M, Ishii K (2016) Potential involvement of obesity-associated chronic inflammation in the pathogenesis of idiopathic spinal epidural lipomatosis. Spine (Phila Pa 1976) 41:E1402–E1407. https://doi.org/10.1097/brs.0000000000001646 CrossRef

Masuzaki H, Paterson J, Shinyama H, Morton NM, Mullins JJ, Seckl JR, Flier JS (2001) A transgenic model of visceral obesity and the metabolic syndrome. Science 294:2166–2170. https://doi.org/10.1126/science.1066285 CrossRefPubMed

Beges C, Rousselin B, Chevrot A, Godefroy D, Vallee C, Berenbaum F, Deshays C, Amor B (1994) Epidural lipomatosis. Interest of magnetic resonance imaging in a weight-reduction treated case. Spine (Phila Pa 1976) 19:251–254CrossRef

10.

Fujiwara A, Kobayashi N, Saiki K, Kitagawa T, Tamai K, Saotome K (2003) Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and short-form 36. Spine (Phila Pa 1976) 28:1601–1607

11.

Naka N, Matsuoka T, Yamamoto H, Mitsuhashi H, Kono J (1998) Lumbar epidural lipomatosis-morphological evaluation of epidural fat. Central Jpn J Orthop Trauma 41:327–328

12.

Kim YU, Kong YG, Lee J, Cheong Y, Kim S, Kim HK, Park JY, Suh JH (2015) Clinical symptoms of lumbar spinal stenosis associated with morphological parameters on magnetic resonance images. Eur Spine J 24:2236–2243. https://doi.org/10.1007/s00586-015-4197-2 CrossRefPubMed

13.

Matsuzawa Y, Funahashi T, Nakamura T (2011) The concept of metabolic syndrome: contribution of visceral fat accumulation and its molecular mechanism. J Atheroscler Thromb 18:629–639CrossRefPubMed

14.

Kvist H, Chowdhury B, Sjöström L, Tylén U, Cederblad A (1988) Adipose tissue volume determination in males by computed tomography and 40K. Int J Obes 12:249–266PubMed

15.

Zając-Gawlak I, Kłapcińska B, Kroemeke A, Pośpiech D, Pelclová J, Přidalová M (2017) Associations of visceral fat area and physical activity levels with the risk of metabolic syndrome in postmenopausal women. Biogerontology 18:357–366. https://doi.org/10.1007/s10522-017-9693-9 CrossRefPubMedPubMedCentral

16.

Shimabukuro M, Kozuka C, S-i Taira, Yabiku K, Dagvasumberel M, Ishida M, Matsumoto S, Yagi S, Fukuda D, Yamakawa K (2013) Ectopic fat deposition and global cardiometabolic risk: new paradigm in cardiovascular medicine. J Med Invest 60:1–14CrossRefPubMed

17.

Oka R, Yagi K, Sakurai M, Nakamura K, Nagasawa SY, Miyamoto S, Nohara A, Kawashiri MA, Hayashi K, Takeda Y, Yamagishi M (2012) Impact of visceral adipose tissue and subcutaneous adipose tissue on insulin resistance in middle-aged Japanese. J Atheroscler Thromb 19:814–822CrossRefPubMed

18.

Ito S, Kamifuku H, Tada E, Yokoyama M, Kobayashi Y, Kuwahata M, Kido Y (2011) A new animal model of visceral fat obesity lnduced by an lnsulin lnjection program. Jpn Soc Nutr Food Sci 64:91–98CrossRef

19.

Després JP, Lemieux I (2006) Abdominal obesity and metabolic syndrome. Nature 444:881–887. https://doi.org/10.1038/nature05488 CrossRefPubMed

20.

Mayes JS, Watson GH (2004) Direct effects of sex steroid hormones on adipose tissues and obesity. Obes Rev 5:197–216. https://doi.org/10.1111/j.1467-789X.2004.00152.x CrossRefPubMed

21.

Yamashita S, Matsuzawa Y, Tokunaga K, Fujioka S, Tarui S (1986) Studies on the impaired metabolism of uric acid in obese subjects: marked reduction of renal urate excretion and its improvement by a low-calorie diet. Int J Obes 10:255–264PubMed

22.

Matsuura F, Yamashita S, Nakamura T, Nishida M, Nozaki S, Funahashi T, Matsuzawa Y (1998) Effect of visceral fat accumulation on uric acid metabolism in male obese subjects: visceral fat obesity is linked more closely to overproduction of uric acid than subcutaneous fat obesity. Metabolism 47:929–933CrossRefPubMed

23.

Avula NR, Shenoy D (2016) Evaluation of Association of Hyperuricaemia with Metabolic Syndrome and Insulin Resistance. J Clin Diagn Res 10:OC32-OC34. https://doi.org/10.7860/jcdr/2016/22182.9113

24.

Porchia LM, Gonzalez-Mejia ME, Torres-Rasgado E, Ruiz-Vivanco G, Pérez-Fuentes R (2017) Low serum uric acid concentration augments insulin effects on the prevalence of metabolic syndrome. Diabetes Metab Syndr. https://doi.org/10.1016/j.dsx.2017.12.012 CrossRefPubMed

25.

Zhu Y, Hu Y, Huang T, Zhang Y, Li Z, Luo C, Luo Y, Yuan H, Hisatome I, Yamamoto T, Cheng J (2014) High uric acid directly inhibits insulin signalling and induces insulin resistance. Biochem Biophys Res Commun 447:707–714. https://doi.org/10.1016/j.bbrc.2014.04.080 CrossRefPubMed

26.

Takahashi S, Yamamoto T, Tsutsumi Z, Moriwaki Y, Yamakita J, Higashino K (1997) Close correlation between visceral fat accumulation and uric acid metabolism in healthy men. Metabolism 46:1162–1165CrossRefPubMed

27.

Swaminathan S, Fonseca VA, Alam MG, Shah SV (2007) The role of iron in diabetes and its complications. Diabetes Care 30:1926–1933. https://doi.org/10.2337/dc06-2625 CrossRefPubMed

28.

Yamada C, Kishimoto N, Yukumatsu N, Takeda A, Ogata T, Kikuchi E, Kuroda E, Motegi S, Ishii N, Nishizaki Y (2016) Serum ferritin and high sensitivity C-reactive protein are associated with metabolic syndrome in Japanese men and women. Health Evaluation and Promotion 43:511–517CrossRef

Title: Lumbar epidural lipomatosis is associated with visceral fat and metabolic disorders
Authors: Shingo Morishita
Yoshiyasu Arai
Toshitaka Yoshii
Kenichiro Sakai
Takashi Hirai
Atsushi Okawa
Publication date: 01-07-2018
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 7/2018
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-018-5584-2

At a glance: The STEP trials

Springer Medicine

Lumbar epidural lipomatosis is associated with visceral fat and metabolic disorders

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

Please log in to get access to this content

Other articles of this Issue 7/2018

Letter to the Editor concerning “Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients” by Sola C, Camino Willhuber G, Kido G et al. Eur Spine J (2018): Doi 10.1007/s00586-018-5547-7

Expert’s comment concerning Grand Rounds case entitled “Management of a high thoracic Chance Fracture” by A. Bourghli et al. (Eur Spine J; 2017. doi:10.1007/s00586-017-5247-8)

Risk factors for sciatica leading to hospitalization

Minimally invasive transpedicular approach for the treatment of central calcified thoracic disc disease: a technical note

Letter to the Editor concerning “Osteoporotic thoracolumbar compression fractures: long-term retrospective comparison between vertebroplasty and conservative treatment” by K. Martikos et al. [Eur Spine J (2018) doi: 10.1007/s00586-018-5605-1]

Great trochanter bursitis vs sciatica, a diagnostic–anatomic trap: differential diagnosis and brief review of the literature