Spinal Epidural Lipomatosis Research Articles

ID: 325287 The Incidence of Negative Outcomes from Epidural Steroid Injections in Patients with Spinal Epidural Lipomatosis

ID: 325287 The Incidence of Negative Outcomes from Epidural Steroid Injections in Patients with Spinal Epidural Lipomatosis

Arthroscopic-assisted uni-portal spinal surgery combined with modified unilateral laminotomy with bilateral decompression for the treatment of lumber epidural lipomatosis: Case report and new therapeutic method

BackgroundLumbar spinal epidural lipomatosis (SEL) is a rare condition characterized by the pathological proliferation of adipose tissue in the epidural space of the spinal canal. This study presents the case of a 59-year-old male with lumbar SEL treated effectively in the short term through arthroscopic-assisted uniportal spinal surgery (AUSS) combined with a modified circle-drawing unilateral laminotomy with bilateral decompression (ULBD) technique. MethodsA modified circle-drawing ULBD procedure was executed via AUSS for a patient with SEL. The procedure involved the excision of diseased adipose tissue from the spinal canal, enlargement and decompression of the spinal canal, liberation of nerves, and post-operative evaluation of imaging results and clinical outcomes. ResultsThe patient exhibited improvements in the dural sac cross-sectional area, low back pain Visual Analogue Score (VAS, leg pain VAS, lumbar spine Japanese Orthopaedic Association (JOA), and EQ-5D post-surgery. ConclusionsAUSS offers comprehensive visualization, straightforward positioning, facilitating a broad field of view and precise lesion management. The modified circle-drawing ULBD technique characterized by its simplicity, operational freedom, and extensive decompression range, contributes to symptom alleviation and patient recovery.

6265243 Spinal epidural lipomatosis: a potential cause of complications with neuraxial anaesthesia in the obstetric population?

6265243 Spinal epidural lipomatosis: a potential cause of complications with neuraxial anaesthesia in the obstetric population?

Minimal Approach to Spinal Epidural Lipomatosis Using the Japanese Step Ladder Technique: A New Technique in 2 Cases

Introduction: Spinal epidural lipomatosis (SEL) refers to a pathological condition characterized by an abnormal accumulation of fat within the epidural space. It’s a rare but well-known condition, that is mostly associated with long-term corticosteroid therapy or elevation of endogenous steroids. Objectives: We aim to present a comprehensive account of our experience with SEL, while also introducing a novel technique and its outcomes. Our approach is informed by a rigorous review of the relevant literature. Results: We report 2 cases of lipomatosis seen in the neurosurgery department. The first was a case of SEL due to obesity, manifested by intermittent claudication. The second case followed a lumbar arthrodesis, with clinical signs associated with radiculopathy. Both patients were treated conservatively, with no improvement, after which we opted for surgical treatment. The postoperative evolution of the 2 cases was marked by regression of symptoms in both patients.

FACTFINDERS for PATIENT SAFETY: Preventing procedure-related complications: Epidural lipomatosis and postpartum steroid exposure

This series of FactFinders presents a brief summary of the evidence and outlines recommendations to improve our understanding and management of potential procedure-related complications.Evidence in support of the following facts is presented. (1) Epidural Steroid injections for Radicular Pain Due to Spinal Stenosis Caused by Lipomatosis -- There is low-level evidence of an association between epidural steroid injections (ESIs) and the development and/or worsening of spinal epidural lipomatosis (SEL). However, there is insufficient evidence to establish whether ESIs independently result in an increase in spinal stenosis with neurological compromise in individuals with pre-existing SEL. (2) Steroid Exposure Postpartum -- There is no absolute contraindication to steroid injections based on postpartum or lactating status, but there may be disruption of both maternal and breastfed child hypothalamic-pituitary-adrenal (HPA) axis response to steroid administration. For the duration of breastfeeding, milk production may be affected after steroid exposure, and withholding breast milk produced for several hours after exposure minimizes infant exposure.

An Unusual Case of Idiopathic Spinal Epidural Lipomatosis

An excess of adipose tissue buildup restricted to the lumbar and thoracic areas of the spine is the cause of spinal epidural lipomatosis. The etiology of spinal epidural lipomatosis can be broadly categorized based on five often related risk factors: obesity, endogenous steroid hormonal disease, spine surgery, exogenous steroid use and idiopathic disease. However, the actual pathophysiology of the condition remains unclear. Neurological impairments, myelopathy, radiculopathy, neurogenic claudication, loss of sensation, difficulties voiding, lower extremity weakness and infrequently cauda equina syndrome might result from the progression of spinal epidural lipomatosis. Conservative treatment focuses on reducing symptoms that result from common risk factors and is primarily patient-specific. Open surgical procedures and minimally invasive surgery have shown to be effective if more advanced means of treatment are required. Here, we report an unusual case of idiopathic spinal epidural lipomatosis. Treatment will depend on the neurological status of the patient. We opted to manage the patient conservatively and closely monitor her on follow up visits.

Transthyretin amyloid deposition in ligamentum flavum (LF) is significantly correlated with LF and epidural fat hypertrophy in patients with lumbar spinal stenosis

Lumbar spinal stenosis (LSS) is a degenerative disease characterized by intermittent claudication and numbness in the lower extremities. These symptoms are caused by the compression of nerve tissue in the lumbar spinal canal. Ligamentum flavum (LF) hypertrophy and spinal epidural lipomatosis in the spinal canal are known to contribute to stenosis of the spinal canal: however, detailed mechanisms underlying LSS are still not fully understood. Here, we show that surgically harvested LFs from LSS patients exhibited significantly increased thickness when transthyretin (TTR), the protein responsible for amyloidosis, was deposited in LFs, compared to those without TTR deposition. Multiple regression analysis, which considered age and BMI, revealed a significant association between LF hypertrophy and TTR deposition in LFs. Moreover, TTR deposition in LF was also significantly correlated with epidural fat (EF) thickness based on multiple regression analyses. Mesenchymal cell differentiation into adipocytes was significantly stimulated by TTR in vitro. These results suggest that TTR deposition in LFs is significantly associated with increased LF hypertrophy and EF thickness, and that TTR promotes adipogenesis of mesenchymal cells. Therapeutic agents to prevent TTR deposition in tissues are currently available or under development, and targeting TTR could be a potential therapeutic approach to inhibit LSS development and progression.

Spinal epidural lipomatosis: A rare complication of Cushing's disease

Spinal epidural lipomatosis: A rare complication of Cushing's disease

Clinical research progress of spinal epidural lipomatosis

To review the clinical research progress of spinal epidural lipomatosis (SEL). 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. 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. 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.

A case report: Unilateral biportal endoscopic revision for adjacent segmental disease: Case presentations and literature review.

Biportal endoscopic revision surgery for adjacent segmental disease (ASD) after lumbar arthrodesis is seldomly reported. Herein, we present 3 cases of ASD with radiculopathy wherein satisfactory results were obtained using unilateral biportal endoscopic (UBE) decompression. Case 1 was of a 56-year-old male who presented with a chief complaint of Intermittent claudication since 2-year. Case 2 involved a 78-year-old female who was admitted to the hospital with a chief complaint of radiating pain and weakness in the left leg for at least 1 year. Case 3 was a 67-year-old woman who visited our hospital because of radiating leg pain for 5 months. All the cases had a history of L4 to L5 lumbar interbody fusion surgery. Computed tomography and magnetic resonance imaging showed the spinal epidural lipomatosis at the L3 to L4 level in case 1, the up-migrated lumbar disc herniation at L3 to L4 level in case 2 and unilateral foraminal stenosis at the L5 to S1 level in case 3. Under UBE guidance, the ipsilateral approach was used to treat adjacent lumbar stenosis caused by spinal epidural lipomatosis. The contralateral approach was used to remove the up-migrated herniated disc. The paraspinal approach was applied to decompress the foraminal stenosis. Postoperative parameters were improved clinically, and nerve roots were decompressed radiologically. No complications were developed. UBE revision surgery showed a favorable clinical and radiological result without complications and may be a safe and effective alternative technique for ASD.

Outcome of posterior decompression for spinal epidural lipomatosis

BackgroundIn 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.MethodsFrom 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.ResultsPatients 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.ConclusionsSurgical 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.

Symptomatic thoracic epidural lipomatosis with syringomyelia: illustrative case.

Spinal epidural lipomatosis is a rare but well-described disease. Here the authors present an extraordinary co-occurrence of spinal epidural lipomatosis with syringomyelia that did not improve after laminoplasty but required duroplasty as a definitive treatment. This is the seventh case in the literature describing a co-occurrence of spinal epidural lipomatosis and syringomyelia. The pragmatic argument for a causative relationship between 2 phenomena is syrinxes reduction after surgery for spinal epidural lipomatosis. Additionally, duroplasty for spinal epidural lipomatosis in the setting of syringomyelia has not previously been reported. Duroplasty offers much better reconstruction of the subarachnoid space as compared with extradural decompression surgeries. It is one of the treatment options for spinal epidural lipomatosis. Last, most of the patients described in the literature with secondary syringomyelia were women with diabetes mellitus. The co-occurrence of spinal epidural lipomatosis and syringomyelia is extremely rare. Neurological deficits in such cases respond well to surgical treatment. Accordingly, each case described in the literature resulted in syringomyelia reduction or resolution after surgery. Duroplasty may be necessary in selected cases of spinal epidural lipomatosis. Close follow-up and ongoing management of patients with epidural lipomatosis is therefore important.

Spinal epidural lipomatosis (SEL).

We present a case of an 87-year-old man with spinal epidural lipomatosis (SEL). The patient had been diagnosed with microscopic polyangiitis and treated with prednisone at a 5mg daily dose. He has a 1-week history of progressive low back pain radiating to the posterior of the right thigh. A spinal magnetic resonance imaging scan revealed SEL in L2-L4. SEL is a rare condition with adipose tissue accumulation in the spinal canal's epidural space, leading to spinal cord or nerve root compression. The greatest risk of SEL is corticosteroid use, and corticosteroid reduction may improve the disease. Physicians should list SEL in the differential diagnosis if a patient on corticosteroid therapy presents with back pain and acute cauda equina symptoms.

Correlation of spinal epidural fat volume with body mass index: a longitudinal study

PurposeSpinal epidural lipomatosis is abnormal accumulation of normal fat in the epidural space with weight loss suggested as first-line therapy in select symptomatic patients. However, moderate to large longitudinal studies establishing concordant changes between body mass index and epidural fat are lacking. The purpose of this study was to longitudinally assess this relationship. MethodsWe performed an ancillary study of the Habitual Diet and Avocado Trial. Baseline and six-month abdominal MRIs were analyzed for 98 overweight or obese but otherwise healthy subjects. Dorsal epidural fat volumes in the lumbar spine were measured and correlated with changes in body mass index, changes in visceral fat volume, and demographic information. ResultsThere was a linear relationship between body mass index changes and epidural fat volume changes with a one-point change in body mass index corresponding to a 45 mm3 change in dorsal epidural fat volume (p < 0.001, 95% CI 31.87 to 76.77) as well as between visceral fat volume changes and epidural fat volume changes (regression coefficient 0.51, p < 0.001, 95% CI 0.22 to 0.47). Age was inversely related with subjects older than 45.7 years tending to lose epidural fat (regression coefficient −0.22, p = 0.025, 95% CI -10.43 to −0.72). ConclusionChanges in spinal dorsal epidural fat volume parallel changes in body mass index and visceral fat, supporting weight loss as initial treatment for uncomplicated obesity-associated spinal epidural lipomatosis.

Spinal epidural lipomatosis in a pediatric patient with a malignant brain tumor: illustrative case.

Spinal epidural lipomatosis (SEL) in pediatric patients with concomitant malignant brain neoplasms is rare and can present with rapid deterioration in neurological function. A 4-year-old boy with SEL became paraplegic 4 months after completion of chemoradiation for his previously resected, intracranial atypical teratoid rhabdoid tumor. The patient presented with rapid deterioration in lower extremity sensory and motor function, which, given his oncological history, was concerning for disease progression. Of note, 8 months prior, the patient was started on corticosteroid therapy for respiratory dysfunction. Magnetic resonance imaging revealed significant progression of lumbosacral SEL requiring surgical decompression with subsequent neurological improvement. When evaluating pediatric patients with primary or metastatic brain tumors with new or worsening myelopathy and motor or sensory deficits, it is important to consider SEL.

Could Spinal Epidural Lipomatosis Be the Hallmark of Metabolic Syndrome on the Spine? A Literature Review with Emphasis on Etiology.

Spinal epidural lipomatosis is defined by an excessive amount of epidural fat in the spinal canal, usually in the lumbosacral tract: a well-known cause of lumbar pain and spinal stenosis with a possible wide range of neurological symptoms. Recent research data reveal that, nowadays, obesity has become the main cause of spinal epidural lipomatosis. Moreover, this condition was recently recognized as a previously unknown manifestation of metabolic syndrome. Radiological studies (CT and MRI) are the only tools that are able to diagnose the disease non-invasively. Indeed, radiologists play a key role in disease recognition, with subsequent possible implications on patients' systemic health assessments. Despite its clinical importance, the condition is still underreported and neglected. The current literature review summarizes all the main etiologies of spinal epidural lipomatosis, particularly regarding its linkage with metabolic syndrome. An overview of disease characteristics from diagnosis to treatment strategies is also provided.

Thoracic epidural lipomatosis as a cause of progressive myelopathy: A case report

Case: A 57-year-old patient diagnosed with panhypopituitarism, chronically managed with steroids, developed a dorsal lipomatosis combined with multiple vertebral fractures, leading to progressive dorsal myelopathy. Surgical management was necessary, and the follow-up showed significant improvements in symptoms and quality of life. Conclusion: Spinal epidural lipomatosis is a condition resulting from excessive fat deposit in epidural space. Patients can be asymptomatic or complain from myelopathic or radicular symptoms. Many etiologies are possible and exogenous steroids excess is one of the most frequent, having a predilection for male sex and thoracic spine. Surgical management is frequently necessary and may provide good results.

Spinal Epidural Lipomatosis Secondary to Hypothyroidism in a Siberian Husky Dog

Spinal Epidural Lipomatosis Secondary to Hypothyroidism in a Siberian Husky Dog

Percutaneous full-endoscopic uniportal decompression for the treatment of symptomatic idiopathic lumbar spinal epidural lipomatosis: Technical note.

BackgroundLumbar spinal epidural lipomatosis (SEL) is a rare condition characterized by an excessive accumulation of adipose tissue within the spinal canal, compressing the dura sac and/or nerve roots. When conservative treatments fail and clinical symptoms progress quickly and seriously, surgical decompression should be considered. With the rapid development of endoscopic armamentaria and techniques, the pathological scope that can be treated by percutaneous endoscopic spine surgery is ever expanding.ObjectiveIn this paper, the authors describe a patient with lumbar spinal epidural lipomatosis who was treated with a percutaneous full-endoscopic uniportal decompression surgery successfully. This article aims to validate the feasibility of percutaneous full-endoscopic uniportal decompression for the treatment of symptomatic idiopathic spinal epidural lipomatosis via interlaminar approach.MethodsWe describe a case of a 69-year-old man with a 10-year history of low back pain, intermittent claudication, and bilateral leg neuropathic pain. He was diagnosed with lumbar epidural lipomatosis, which did not respond to conservative therapy. After a comprehensive evaluation, he underwent percutaneous endoscopic spine surgery to remove hyperplastic adipose tissue and decompress nerve roots and dura sac.ResultsThe patient was treated with a percutaneous full-endoscopic uniportal decompression surgery successfully. After the procedure, his leg pain decreased and his walking capacity improved. There were no surgery-related complications, such as cerebrospinal fluid leakage, incision infection, etc.ConclusionsThe case with SEL was successfully treated with a percutaneous full-endoscopic uniportal surgery, which has the advantages of excellent presentation of anatomical structures, expanded field of vision, less surgical-related trauma, and bleeding. The key point of the procedure is to release and cut off the bands which divide the epidural space into small rooms filled with excess adipose tissue.

Clinical and radiological characteristics of spinal epidural lipomatosis: A retrospective review of 90 consecutive patients

BackgroundThe epidemiology and clinical characteristics of spinal epidural lipomatosis (SEL) have been well-reported in the literature. However, few studies investigated the concomitant spinal pathologies that were present in patients with SEL. Therefore, we aimed to summarize the clinical and radiological characteristics of patients with SEL diagnosed on spinal imaging. MethodsPatients who were diagnosed with SEL on magnetic resonance imaging from January 2018 to October 2020 at our institution were included in the study. Clinical data was collected using a standardized data collection form. SEL was graded using a modified version of the Borré grading system. Factors associated with moderate or severe SEL were determined using multiple logistic regression. ResultsA total of 90 patients were included in the analysis. The mean (±SD) age was 59.3 (±17.1) years, and 62 patients (68.9%) were male. 61 patients (67.8%) had moderate or severe SEL. Most patients were overweight or obese (57 patients, 63.3%). The most common presenting symptoms was back pain (57 patients, 63.3%). SEL was diagnosed incidentally in 42 patients (46.7%). The lumbar spine was the most common site of SEL (35 patients, 38.9%). The most common concomitant spinal pathologies were disc bulge (83 patients, 92.2%) and flavum hypertrophy (60 patients, 66.7%). Moderate or severe SEL was associated with WHO Obesity Class, back pain or radicular leg pain at first presentation, and SEL that was worst at the lumbar or lumbosacral spinal level. ConclusionsModerate or severe SEL were independently associated with WHO Obesity Class, back pain, radicular leg pain, and SEL that was worst at the lumbar or lumbosacral spinal level. Future studies should prospectively evaluate whether weight loss therapy is warranted in patients with SEL.