Skip to main content

Advertisement

SpringerLink
Log in

Treatment results for lumbar epidural lipomatosis: Does fat matter?

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

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 (NRSback_LEL_preop. = 6.4; NRSback_CSS_preop. = 6.3; NRSback_LEL_3-years = 3.2; NRSback_CSS_3-years = 3.6; NRSleg_LEL_preop. = 6.3; NRSleg_CSS_preop. = 6.5; NRSleg_LEL_3-years = 2.5; NRSleg_CSS_3-years = 2.9; ODILEL_preop. = 52.7; ODICSS_preop = 51.8; ODILEL_3-years = 32.3; ODICSS_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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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

    Article  PubMed  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  Google Scholar 

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

    CAS  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany

    Simon Heinrich Bayerl, Malte Dinkelbach, Vincent Prinz, Tobias Finger & Peter Vajkoczy

  2. Department of Neurosurgery, University of Cologne, Cologne, Germany

    Petra Heiden

Authors
  1. Simon Heinrich Bayerl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Malte Dinkelbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Petra Heiden
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vincent Prinz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tobias Finger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Peter Vajkoczy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Peter Vajkoczy.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional research comittee (reference number: EA1/101/17) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All authors confirmed consent for publication.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 7257 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bayerl, S.H., Dinkelbach, M., Heiden, P. et al. Treatment results for lumbar epidural lipomatosis: Does fat matter?. Eur Spine J 28, 69–77 (2019). https://doi.org/10.1007/s00586-018-5771-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-018-5771-1

Keywords

Search

Navigation