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

Abstract

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.

Image-Guided Minimally Invasive Treatment Options for Degenerative Lumbar Spine Disease: A Practical Overview of Current Possibilities

“…Including epidural lipomatosis among the main causes of stenosis with disc pathology and arthritis is an important and unique feature of this grading system. Recent literature has recognized that hypertrophy of epidural fat is one of the key elements in the development of symptoms and lumbar stenosis [50][51][52]. MRI is considered the most sensitive and comprehensive imaging tool available for the study of the lumbar spine, providing information in regard to all the structures involved in the pathogenesis of low back pain, including bone, disc, neural roots, facet joints, ligaments, paravertebral muscles, spinal canal, neural foramina, and epidural fat.…”

“…Including epidural lipomatosis among the main causes of stenosis with disc pathology and arthritis is an important and unique feature of this grading system. Recent literature has recognized that hypertrophy of epidural fat is one of the key elements in the development of symptoms and lumbar stenosis [ 50 , 51 , 52 ].…”

Unilateral biportal endoscopy vs. open decompression for lumbar epidural lipomatosis-cohort study using a prospective registry

“…LEL is a rare disease in clinical practice; however, approximately 6% of symptomatic cases of lumbar spinal stenosis are associated with LEL ( 2 , 3 ). Clinical manifestations include nerve root and cauda equina compression injury symptoms, such as neurogenic claudication, loss of sensation, lower limb weakness, cauda equina syndrome, and so on ( 3 , 4 ). If symptoms are mild, conservative treatment should be administered.…”

“…Recent studies have indicated that the diagnosis rate of LEF is only 8%, and it is easily missed or misdiagnosed in clinical practice, which may delay the optimal treatment time and affect a patient's quality of life ( 4 , 5 ). Research on the diagnosis and treatment of LEF has increased in recent years, and numerous effective treatment methods have been proposed ( 6 ).…”

Editorial for “Evaluation of the Reproducibility of MR Elastography Measurements of the Lumbar Back Muscles”

“…Among spinal factors are included fractures, tumors, infections, inflammatory diseases, intervertebral disc pathologies, spondyloarthritis, spondylolisthesis, facet arthropathies, sacroiliac joint disease, and spinal epidural lipomatosis. 4,5 All these causes can play a role singularly or in combination. Notably, in the elderly, the association of many causes is frequently found simultaneously.…”