Treatment results for lumbar epidural lipomatosis: Does fat matter?

Simon Heinrich Bayerl; Malte Dinkelbach; Petra Heiden; Vincent Prinz; Tobias Finger; Peter Vajkoczy

doi:10.1007/s00586-018-5771-1

Treatment results for lumbar epidural lipomatosis: Does fat matter?

Eur Spine J. 2019 Jan;28(1):69-77. doi: 10.1007/s00586-018-5771-1. Epub 2018 Oct 1.

Authors

Simon Heinrich Bayerl¹, Malte Dinkelbach¹, Petra Heiden², Vincent Prinz¹, Tobias Finger¹, Peter Vajkoczy³

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.
² Department of Neurosurgery, University of Cologne, Cologne, Germany.
³ 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. peter.vajkoczy@charite.de.

PMID: 30276467
DOI: 10.1007/s00586-018-5771-1

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. These slides can be retrieved under Electronic Supplementary Material.

Keywords: Lumbar spinal stenosis; Microsurgical decompression; Quality of life; Spinal epidural lipomatosis; Walking distance.

MeSH terms

Humans
Lipomatosis* / physiopathology
Lipomatosis* / surgery
Lumbar Vertebrae / surgery*
Microsurgery / adverse effects
Microsurgery / methods
Microsurgery / statistics & numerical data
Patient Satisfaction
Quality of Life
Spinal Diseases* / physiopathology
Spinal Diseases* / surgery
Treatment Outcome