Top

European Spine Journal

Published in:

01-01-2019 | Original Article

Treatment results for lumbar epidural lipomatosis: Does fat matter?

Authors: Simon Heinrich Bayerl, Malte Dinkelbach, Petra Heiden, Vincent Prinz, Tobias Finger, Peter Vajkoczy

Published in: European Spine Journal | Issue 1/2019

Abstract

Purpose

The lumbar epidural lipomatosis (LEL) is a rare disease that can cause sciatic pain syndrome or neurological deficits comparable to symptoms caused by a classical spinal canal stenosis. In severe cases surgical decompression was conducted. However, the outcome after decompressive surgery has only been investigated in small case series. In this study we compared the outcome of LEL patients after microsurgery with the outcome of patients with classical spinal stenosis (CSS).

Methods

Patients with LEL (n = 38) and patients with CSS (n = 51), who received microsurgical decompression, were followed in a prospective observational study for 3 years. The clinical results including the Oswestry Disability Index, Numeric Pain Rating Scale (NRS), Roland and Morris Disability Questionnaire, the Short Form-36 Score and the Walking Distance were analysed and compared between both groups.

Results

Patients with LEL improved significantly after microsurgical decompression in a 3-year follow-up concerning back pain, leg pain and pain-associated disability equal to patients with CSS (NRS_{back_LEL_preop.} = 6.4; NRS_{back_CSS_preop.} = 6.3; NRS_{back_LEL_3-years} = 3.2; NRS_{back_CSS_3-years} = 3.6; NRS_{leg_LEL_preop.} = 6.3; NRS_{leg_CSS_preop.} = 6.5; NRS_{leg_LEL_3-years} = 2.5; NRS_{leg_CSS_3-years} = 2.9; ODI_{LEL_preop.} = 52.7; ODI_{CSS_preop} = 51.8; ODI_{LEL_3-years} = 32.3; ODI_{CSS_3-years} = 27.6). The microsurgical decompression had a positive effect on the health-related quality of life, and patient satisfaction was high in both groups (LEL group—71%, CSS group—69%).

Conclusions

LEL can influence the quality of life dramatically and cause a high degree of disability. A surgical decompression is a safe and effective procedure with a good clinical outcome comparable to the results in patients with an osteoligamentous spinal stenosis. Therefore, microsurgical decompression can be recommended in patients with LEL if conservative treatment fails.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Available only for authorised users

Morishita S, Arai Y, Yoshii T et al (2018) Lumbar epidural lipomatosis is associated with visceral fat and metabolic disorders. Eur Spine J. https://doi.org/10.1007/s00586-018-5584-2 CrossRefPubMed

Malone JB, Bevan PJ, Lewis TJ et al (2018) Incidence of spinal epidural lipomatosis in patients with spinal stenosis. J Orthop 15:36–39. https://doi.org/10.1016/j.jor.2017.11.001 CrossRefPubMed

Borré DG, Borré GE, Aude F, Palmieri GN (2003) Lumbosacral epidural lipomatosis: MRI grading. Eur Radiol 13:1709–1721. https://doi.org/10.1007/s00330-002-1716-4 CrossRefPubMed

Ishikawa Y, Shimada Y, Miyakoshi N et al (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

Barrey C, Roussouly P, Le Huec J-C et al (2013) Compensatory mechanisms contributing to keep the sagittal balance of the spine. Eur Spine J 22(Suppl 6):S834–S841. https://doi.org/10.1007/s00586-013-3030-z CrossRefPubMed

Barrey C, Roussouly P, Perrin G, Le Huec J-C (2011) Sagittal balance disorders in severe degenerative spine. Can we identify the compensatory mechanisms? Eur Spine J 20 Suppl 5:626–633. https://doi.org/10.1007/s00586-011-1930-3 CrossRefPubMed

Thomé C, Zevgaridis D, Leheta O et al (2005) Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3:129–141. https://doi.org/10.3171/spi.2005.3.2.0129 CrossRefPubMed

Weinstein JN, Tosteson TD, Lurie JD et al (2010) Surgical versus nonoperative treatment for lumbar spinal stenosis four-year results of the spine patient outcomes research trial. Spine (Phila Pa 1976) 35:1329–1338. https://doi.org/10.1097/BRS.0b013e3181e0f04d CrossRef

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

10.

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

11.

Yildirim B, Puvanesarajah V, An HS et al (2016) Lumbosacral epidural lipomatosis: a retrospective matched case-control database study. World Neurosurg 96:209–214. https://doi.org/10.1016/j.wneu.2016.08.125 CrossRefPubMed

12.

Al-Yafeai R, Maghrabi Y, Malibary H, Baeesa S (2017) Spinal cord compression secondary to idiopathic thoracic epidural lipomatosis in an adolescent: a case report and review of literature. Int J Surg Case Rep 37:225–229. https://doi.org/10.1016/j.ijscr.2017.06.041 CrossRefPubMedPubMedCentral

13.

Borstlap ACW, van Rooij WJJ, Sluzewski M et al (1995) Reversibility of lumbar epidural lipomatosis in obese patients after weight-reduction diet. Neuroradiology 37:670–673. https://doi.org/10.1007/s002340050177 CrossRefPubMed

14.

Kniprath K, Farooque M (2017) Drastic weight reduction decrease in epidural fat and concomitant improvement of neurogenic claudicatory symptoms of spinal epidural lipomatosis. Pain Med. https://doi.org/10.1093/pm/pnw313 CrossRefPubMed

15.

Fassett DR, Schmidt MH (2004) Spinal epidural lipomatosis: a review of its causes and recommendations for treatment. Neurosurg Focus 16:E11. https://doi.org/10.3171/foc.2004.16.4.12 CrossRef

16.

Cushnie D, Urquhart JC, Gurr KR et al (2018) Obesity and spinal epidural lipomatosis in cauda equina syndrome. Spine J 18(3):407–413. https://doi.org/10.1016/j.spinee.2017.07.177 CrossRefPubMed

17.

Weinstein JN, Lurie JD, Tosteson TD et al (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–2270. https://doi.org/10.1056/NEJMoa070302 CrossRefPubMedPubMedCentral

18.

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

19.

Ferlic PW, Mannion AF, Jeszenszky D et al (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

20.

Ross R, Shaw KD, Rissanen J et al (1994) Sex differences in lean and adipose tissue distribution by magnetic resonance imaging: anthropometric relationships. Am J Clin Nutr 59:1277–1285. https://doi.org/10.1093/ajcn/59.6.1277 CrossRefPubMed

21.

Theyskens NC, Paulino Pereira NR, Janssen SJ et al (2017) The prevalence of spinal epidural lipomatosis on magnetic resonance imaging. Spine J 17:969–976. https://doi.org/10.1016/j.spinee.2017.02.010 CrossRefPubMed

22.

Al-Omari AA, Phukan RD, Leonard DA et al (2016) Idiopathic spinal epidural lipomatosis in the lumbar spine. Orthopedics 39:163–168. https://doi.org/10.3928/01477447-20160315-04 CrossRefPubMed

Title: Treatment results for lumbar epidural lipomatosis: Does fat matter?
Authors: Simon Heinrich Bayerl
Malte Dinkelbach
Petra Heiden
Vincent Prinz
Tobias Finger
Peter Vajkoczy
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 1/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-018-5771-1

At a glance: The STEP trials

Springer Medicine

Treatment results for lumbar epidural lipomatosis: Does fat matter?

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 1/2019

Minimally invasive spinal decompression surgery in diabetic patients: perioperative risks, complications and clinical outcomes compared with non-diabetic patients’ cohort

Correction to: Can spinal surgery in England be saved from litigation: a review of 978 clinical negligence claims against the NHS

Impact of lumbar hypolordosis on the incidence of symptomatic postoperative spinal epidural hematoma after decompression surgery for lumbar spinal canal stenosis

Letter to the Editor concerning “Relationship between sagittal spinal curves geometry and isokinetic trunk muscle strength in adults” by Elsayed W, Farrag A, Muaidi Q, Almulhim N (Eur Spine J [2018] 27:2014–2022)

Letter to the Editor concerning “Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning” by Obeid I et al. [Eur Spine J; (2016) 25: 3644–3649]

The prevalence and impact of frailty in patients with symptomatic lumbar spinal stenosis