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Open Access 25-09-2023 | Spinal Stenosis | Original Article

Outcome of posterior decompression for spinal epidural lipomatosis

Authors: Michael Schmutzer-Sondergeld, Hanna Zimmermann, Raimund Trabold, Thomas Liebig, Christian Schichor, Sebastian Siller

Published in: Acta Neurochirurgica | Issue 11/2023

Abstract

Background

In contrast to osteoligamentous lumbar stenosis (LSS), outcome of surgical treatment for spinal epidural lipomatosis (SEL) is still not well defined. We present risk factors for SEL and clinical long-term outcome data after surgical treatment for patients with pure SEL and a mixed-type pathology with combined SEL and LSS (SEL+LSS) compared to patients with pure LSS.

Methods

From our prospective institutional database, we identified all consecutive patients who were surgically treated for newly diagnosed SEL (n = 31) and SEL+LSS (n = 26) between 2018 and 2022. In addition, a matched control group of patients with pure LSS (n = 30) was compared. Microsurgical treatment aimed for posterior decompression of the spinal canal. Study endpoints were outcome data including clinical symptoms at presentation, MR-morphological analysis, evaluation of pain-free walking distance, pain perception by VAS-N/-R scales, and patient’s satisfaction by determination of the Odom score.

Results

Patients with osteoligamentous SEL were significantly more likely to suffer from obesity (body mass index (BMI) of 30.2 ± 5.5 kg/m², p = 0.03), lumbar pain (p = 0.006), and to have received long-term steroid therapy (p = 0.01) compared to patients with SEL+LSS and LSS. In all three groups, posterior decompression of the spinal canal resulted in significant improvement of these symptoms. Patients with SEL had a significant increase in pain-free walking distance during the postoperative course, at discharge, and last follow-up (FU) (p < 0.0001), similar to patients with SEL+LSS and pure LSS. In addition, patients with pure SEL and SEL+LSS had a significant reduction in pain perception, represented by smaller values of VAS-N and -R postoperatively and at FU, similar to patients with pure LSS. In uni- and multivariate analysis, domination of lumbar pain and steroid long-term therapy were significant characteristic risk factors for SEL.

Conclusions

Surgical treatment of pure SEL and SEL+LSS allows significant improvement in pain-free walking distance and pain perception immediately postoperatively and in long-term FU, similar to patients with pure LSS.

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Title: Outcome of posterior decompression for spinal epidural lipomatosis
Authors: Michael Schmutzer-Sondergeld
Hanna Zimmermann
Raimund Trabold
Thomas Liebig
Christian Schichor
Sebastian Siller
Publication date: 25-09-2023
Publisher: Springer Vienna
Keyword: Spinal Stenosis
Published in: Acta Neurochirurgica / Issue 11/2023
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-023-05814-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Outcome of posterior decompression for spinal epidural lipomatosis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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